{"hospital_name":"HCA FLORIDA OCALA 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 OCALA HOSPITAL","HCA FL SUMMERFIELD ER","HCA FL MARICAMP ER","HCA FL TRAILWINDS VILLAGE ER","HCA FL SILVER SPRINGS ER","HCA FL FOXWOOD ER"],"hospital_address":["1431 SW 1ST AVENUE, OCALA, FL, 34474","14193 S US HIGHWAY 441, SUMMERFIELD, FL, 34491","2897 SE MARICAMP RD, OCALA, FL, 34471","6131 SEVEN MILE DR, WILDWOOD, FL, 34785","3741 E. SILVER SPRINGS BLVD., OCALA, FL, 34470","4361 NW BLITCHTON RD, OCALA, FL, 34482"],"license_information":{"hospital_license_number":"4001","state":"FL"},"standard_charge_information":[{"description":"MAJOR MULTIPLE TRAUMA NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"158","type":"RC"},{"code":"C1701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17350.78,"maximum":20090.38,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19177.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19359.82,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17350.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18263.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20090.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18263.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19177.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17350.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17716.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18263.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18263.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18263.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17898.70,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"138","type":"RC"},{"code":"D1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23108.77,"maximum":26757.53,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25541.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25784.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23108.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26757.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25541.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23108.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23595.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23838.52,"methodology":"fee schedule"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":54554.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11033.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11357.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11466.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11141.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11769.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15833.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11769.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10925.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10925.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17846.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27659.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17846.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11769.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11466.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11898.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":54554.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22586.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":54554.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11141.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11033.35,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18304.44,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":19219.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11357.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11249.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11574.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10492.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11357.86,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11466.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21093.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13521.26,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11357.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10979.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11033.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10351.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10817.01,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21093.17,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10817.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10817.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10979.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10600.67,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21093.17,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 27.85 & M < 38.75 ","code_information":[{"code":"118","type":"RC"},{"code":"D2003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21955.17,"maximum":25421.78,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24266.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24497.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21955.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23110.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25421.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23110.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24266.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21955.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22417.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23110.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23110.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23110.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22648.49,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0158U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":282.88,"maximum":594.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":322.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.46,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":594.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":594.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":594.05,"methodology":"fee schedule"}]}]},{"description":"MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant ","code_information":[{"code":"81305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175.40,"maximum":368.34,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":192.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":187.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.92,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":185.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":199.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":187.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":187.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":210.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":368.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":201.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":176.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":368.34,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":184.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":368.34,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M < 25.85 ","code_information":[{"code":"148","type":"RC"},{"code":"D0604","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29058.76,"maximum":33646.98,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32117.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32423.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29058.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30588.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33646.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30588.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32117.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29058.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29670.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30588.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30588.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30588.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29976.40,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 16 ","code_information":[{"code":"1553","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1401.41,"maximum":2942.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1541.56,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1499.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1485.50,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1485.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1429.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1429.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1597.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1541.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1499.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1541.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1499.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1429.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1681.70,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2942.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1611.63,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1408.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2942.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1471.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1401.41,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2942.97,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 6 ","code_information":[{"code":"1543","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":435.26,"maximum":914.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":478.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":465.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":461.37,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":461.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":443.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":443.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":496.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":478.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":465.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":478.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":465.72,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":443.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":522.31,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":914.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":500.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":437.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":914.04,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":457.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":914.04,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 26.15 & M < 35.05 ","code_information":[{"code":"118","type":"RC"},{"code":"D0303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22880.06,"maximum":26492.70,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25288.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25529.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22880.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24084.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26492.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24084.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25288.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22880.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23361.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24084.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24084.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24084.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23602.58,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"148","type":"RC"},{"code":"D0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14708.01,"maximum":17030.33,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16256.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16411.04,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14708.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17030.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16256.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14708.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15017.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15172.47,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"138","type":"RC"},{"code":"B0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30486.15,"maximum":35299.75,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33695.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34016.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30486.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32090.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35299.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32090.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33695.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30486.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31127.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32090.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32090.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32090.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31448.87,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast cancer), ERBB2 (HER2) copy number by FISH, tumor cells from formalin fixed paraffin embedded tissue isolated using image-based dielectrophoresis (DEP) sorting, reported as ERBB2 gene ","code_information":[{"code":"0009U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107.00,"maximum":224.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":117.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":114.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":113.42,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":113.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":109.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":109.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":121.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":117.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":114.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":117.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":114.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":109.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":128.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":224.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":123.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":107.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":224.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":112.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":224.70,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid tumor), DNA (80 genes) & RNA (36 genes), by next-generation sequencing from plasma, including single nucleotide variants, insertions, deletions, copy number alterations, microsatellite ","code_information":[{"code":"0409U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2919.60,"maximum":6131.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3094.78,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3094.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3328.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3503.52,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6131.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3357.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2934.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6131.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3065.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6131.16,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M=39-47 ","code_information":[{"code":"118","type":"RC"},{"code":"B1204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36456.17,"maximum":42212.41,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40293.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40677.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36456.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42212.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40293.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36456.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37223.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37607.42,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC ","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":32740.71,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6863.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7065.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7132.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6930.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":3711.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4992.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3711.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6796.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6796.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":5627.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":8721.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":5627.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":3711.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7132.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7401.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":32740.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13555.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32740.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6930.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6863.60,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10985.31,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":11534.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7065.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6998.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7200.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6527.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7065.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7132.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13121.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8411.28,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7065.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6829.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6863.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6439.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6729.02,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13121.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6729.02,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6729.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6829.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6594.44,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13121.59,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES ","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52359.72,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10613.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10925.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11030.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10717.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11194.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15060.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11194.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10509.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10509.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16974.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26307.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16974.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11194.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11030.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11446.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52359.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21677.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52359.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10717.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10613.78,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17567.97,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":18446.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10925.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10821.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11134.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10093.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10925.95,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11030.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20291.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13007.09,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10925.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10561.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10613.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9958.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10405.67,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20291.06,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10405.67,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10405.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10561.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10197.56,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20291.06,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 44.75 ","code_information":[{"code":"118","type":"RC"},{"code":"A0901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":13702.99,"maximum":15866.62,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15145.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15289.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13702.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14424.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15866.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14424.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15145.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13702.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13991.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14424.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14424.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14424.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14135.72,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 26.75 & M < 37.15 ","code_information":[{"code":"138","type":"RC"},{"code":"C1602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18604.55,"maximum":21542.11,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20562.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20758.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18604.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19583.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21542.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19583.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20562.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18604.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18996.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19583.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19583.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19583.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19192.06,"methodology":"fee schedule"}]}]},{"description":"Peanut allergen-specific quantitative assessment of multiple epitopes using enzyme-linked immunosorbent assay (ELISA), blood, report of minimum eliciting exposure for a clinical reaction ","code_information":[{"code":"0178U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":459.86,"maximum":965.71,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":505.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":492.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":487.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":487.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":469.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":469.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":524.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":505.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":492.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":505.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":492.05,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":469.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":551.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":965.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":528.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":462.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":965.71,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":482.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":459.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":965.71,"methodology":"fee schedule"}]}]},{"description":"Plt, pher, l/r cmv-neg, i ","code_information":[{"code":"9531","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":518.19,"maximum":1088.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":570.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":554.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":549.28,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":549.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":528.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":528.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":590.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":570.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":554.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":570.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":554.46,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":528.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":621.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1088.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":595.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":520.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1088.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":544.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":518.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1088.20,"methodology":"fee schedule"}]}]},{"description":"Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid) ","code_information":[{"code":"84157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.63,"maximum":8.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8.40,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M < 29.15 ","code_information":[{"code":"128","type":"RC"},{"code":"B1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37970.38,"maximum":43965.70,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41967.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42366.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":37970.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":43965.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41967.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37970.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38769.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39169.44,"methodology":"fee schedule"}]}]},{"description":"Pyruvate ","code_information":[{"code":"84210","type":"CPT"},{"code":"L000183502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.12,"maximum":30.41,"gross_charge":62.15,"discounted_cash":62.15,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30.41,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.48,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30.41,"methodology":"fee schedule"}]}]},{"description":"Radiation tx delivery imr ","code_information":[{"code":"4015","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":328.73,"maximum":690.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":361.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":351.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":348.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":348.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":335.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":335.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":374.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":361.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":351.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":361.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":351.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":335.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":394.47,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":690.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":378.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":330.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":690.33,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":345.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":328.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":690.33,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (MNS blood group) genotyping (GYPB), gene analysis, GYPB (glycophorin B) introns 1, 5, pseudoexon 3 ","code_information":[{"code":"0190U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274.83,"maximum":577.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":313.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":577.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":577.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":577.14,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"138","type":"RC"},{"code":"C0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23023.63,"maximum":26658.94,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25447.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25689.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23023.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24235.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26658.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24235.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25447.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23023.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23508.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24235.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24235.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24235.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23750.69,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 22.05 & ","code_information":[{"code":"148","type":"RC"},{"code":"D0805","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25175.57,"maximum":29150.66,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27825.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28090.64,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25175.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26500.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29150.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26500.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27825.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25175.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25705.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26500.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26500.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26500.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25970.59,"methodology":"fee schedule"}]}]},{"description":"RESPIRATORY SIGNS AND SYMPTOMS ","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35527.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7396.23,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7613.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7686.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7468.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8642.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11627.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8642.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7323.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7323.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13105.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20311.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13105.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8642.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7686.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7976.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35527.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14708.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35527.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7468.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7396.23,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11920.23,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":12516.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7613.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7541.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7758.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7033.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7613.77,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7686.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":14139.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9064.01,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7613.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7359.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7396.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6939.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7251.21,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":14139.85,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7251.21,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7251.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7359.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7106.18,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":14139.85,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"D1301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14367.44,"maximum":16635.98,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15879.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16031.04,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14367.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15123.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16635.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15123.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15879.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14367.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14669.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15123.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15123.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15123.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14821.15,"methodology":"fee schedule"}]}]},{"description":"Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes ","code_information":[{"code":"97533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57.86,"maximum":125.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":65.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":63.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":63.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":68.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":65.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":63.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":65.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":63.83,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":57.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":71.58,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":125.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":68.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":59.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":125.27,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":62.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":125.27,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC ","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":116653.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22903.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23577.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23801.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":23128.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14954.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20119.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14954.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22679.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22679.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22676.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35145.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22676.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14954.47,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23801.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24699.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":116653.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":48296.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":116653.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23128.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22903.62,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":39140.22,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":41097.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23577.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":23352.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24026.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21780.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23577.26,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":23801.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":43786.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28068.16,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":23577.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22791.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22903.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21488.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22454.53,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":43786.33,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":22454.53,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":22454.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22791.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22005.44,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":43786.33,"methodology":"fee schedule"}]}]},{"description":"Specific gravity (except urine) ","code_information":[{"code":"84315","type":"CPT"},{"code":"L000188301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2.97,"maximum":6.89,"gross_charge":14.10,"discounted_cash":14.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"128","type":"RC"},{"code":"A0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32220.73,"maximum":37308.21,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35612.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35951.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32220.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37308.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35612.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32220.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32899.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33238.22,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C < 18.5 ","code_information":[{"code":"128","type":"RC"},{"code":"B0103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26731.52,"maximum":30952.28,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29545.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29826.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26731.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28138.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30952.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28138.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29545.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26731.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27294.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28138.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28138.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28138.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27575.67,"methodology":"fee schedule"}]}]},{"description":"T cells; absolute CD4 count ","code_information":[{"code":"86361","type":"CPT"},{"code":"L000269402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.27,"maximum":56.24,"gross_charge":35.15,"discounted_cash":35.15,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":56.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":56.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":56.24,"methodology":"fee schedule"}]}]},{"description":"Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing act ","code_information":[{"code":"97112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31.80,"maximum":68.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":33.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39.34,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":68.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":37.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":68.84,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":68.84,"methodology":"fee schedule"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITH MCC ","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":127760.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25026.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25762.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26008.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":25271.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7778.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10465.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7778.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24781.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24781.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11795.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18280.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11795.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7778.64,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26008.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26989.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":127760.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":52895.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":127760.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25271.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25026.60,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":42866.67,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":45010.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25762.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":25517.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26253.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23799.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25762.67,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":26008.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":47844.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30669.85,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":25762.67,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24903.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25026.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23480.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24535.88,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":47844.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":24535.88,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":24535.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24903.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24045.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":47844.97,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"128","type":"RC"},{"code":"B0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34387.70,"maximum":39817.33,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":38007.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38369.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34387.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36197.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":39817.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36197.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38007.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34387.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35111.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36197.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":36197.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36197.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35473.62,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & C < 23.5 ","code_information":[{"code":"148","type":"RC"},{"code":"D0203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20741.47,"maximum":24016.44,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22924.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23143.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20741.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24016.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22924.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20741.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21178.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21396.46,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"138","type":"RC"},{"code":"D0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34928.60,"maximum":40443.65,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":38605.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38972.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34928.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40443.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38605.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34928.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35663.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36031.61,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"138","type":"RC"},{"code":"C0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23092.08,"maximum":26738.20,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25522.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25765.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23092.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26738.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25522.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23092.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23578.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23821.30,"methodology":"fee schedule"}]}]},{"description":"Unexplained constitutional or other heritable disorders or syndromes, tissue-specific gene expression by whole-transcriptome and next-generation sequencing, blood, formalin-fixed paraffin-embedded (FF ","code_information":[{"code":"0266U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3200.00,"maximum":6720.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3520.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3424.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3392.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3392.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3264.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3264.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3648.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3520.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3424.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3520.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3424.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3264.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3840.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6720.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3680.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3216.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6720.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3360.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6720.00,"methodology":"fee schedule"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC ","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29123.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":11420.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11296.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":11420.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":9306.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11628.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11739.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":19540.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9471.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":17942.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11407.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6007.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8082.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6007.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11185.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11185.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9110.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14118.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9110.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6007.70,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11739.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12182.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29123.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12057.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29123.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11407.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11296.32,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9133.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":9590.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11628.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11517.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11850.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10742.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11628.56,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":8916.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11739.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21595.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13843.52,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11628.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11240.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":7389.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11296.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10598.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11074.82,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21595.90,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11074.82,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11074.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11240.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10853.32,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21595.90,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M=39-45 ","code_information":[{"code":"118","type":"RC"},{"code":"C1004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31771.64,"maximum":36788.22,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35116.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35450.46,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":31771.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33443.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36788.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33443.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35116.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31771.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32440.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33443.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33443.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33443.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32774.96,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M > 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"C1101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16976.82,"maximum":19657.37,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18763.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18942.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16976.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19657.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18763.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16976.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17334.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17512.93,"methodology":"fee schedule"}]}]},{"description":"Antibody screen, RBC, each serum technique ","code_information":[{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.77,"maximum":20.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20.52,"methodology":"fee schedule"}]}]},{"description":"Antibody; parvovirus ","code_information":[{"code":"86747","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.62,"maximum":31.56,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":31.56,"methodology":"fee schedule"}]}]},{"description":"ATM (ataxia telangiectasia mutated) (eg, ataxia telangiectasia) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0136U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":407.43,"maximum":855.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":448.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":435.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":431.88,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":431.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":415.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":415.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":464.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":448.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":435.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":448.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":435.95,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":415.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":488.92,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":855.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":468.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":409.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":855.60,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":427.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":407.43,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":855.60,"methodology":"fee schedule"}]}]},{"description":"Behavioral and qualitative analysis of voice and resonance ","code_information":[{"code":"92524","type":"CPT"},{"code":"T000026902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":104.77,"maximum":226.82,"gross_charge":988.40,"discounted_cash":988.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":115.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":114.49,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":114.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":110.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":110.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":123.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":115.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":115.57,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":110.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":104.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":129.61,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":226.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":124.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":108.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":226.82,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":113.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":108.01,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":226.82,"methodology":"fee schedule"}]}]},{"description":"Blood split unit ","code_information":[{"code":"9520","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":149.07,"maximum":313.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":163.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":159.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":158.01,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":158.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":152.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":152.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":169.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":163.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":159.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":163.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":159.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":152.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":178.88,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":313.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":171.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":149.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":313.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":156.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":149.07,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":313.05,"methodology":"fee schedule"}]}]},{"description":"BURNS; M > 0 ","code_information":[{"code":"148","type":"RC"},{"code":"A2101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16304.02,"maximum":18878.34,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18020.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18191.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16304.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17162.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18878.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17162.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18020.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16304.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16647.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17162.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17162.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17162.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16818.89,"methodology":"fee schedule"}]}]},{"description":"C-reactive protein; high sensitivity (hsCRP) ","code_information":[{"code":"86141","type":"CPT"},{"code":"L000225801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.74,"maximum":27.20,"gross_charge":327.30,"discounted_cash":327.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.20,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"118","type":"RC"},{"code":"A1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19704.73,"maximum":22816.00,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21778.91,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21986.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19704.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20741.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22816.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20741.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21778.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19704.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20119.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20741.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20741.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20741.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20326.98,"methodology":"fee schedule"}]}]},{"description":"Cardiology (Coronary Artery Disease), analysis of 3 proteins with 3 clinical parameters, plasma, algorithm reported as a risk score for obstructive CAD ","code_information":[{"code":"0308U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":390.75,"maximum":820.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":414.19,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":414.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":445.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":468.90,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":820.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":449.36,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":392.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":820.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":410.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":820.58,"methodology":"fee schedule"}]}]},{"description":"CERVICAL SPINAL FUSION WITH MCC ","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":88296.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":27516.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41281.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":27516.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22425.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":42495.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42899.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":29603.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":41685.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":42158.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":67861.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":42158.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":40876.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":40876.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":59600.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58501.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":59600.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":42158.00,"methodology":"case rate"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":42899.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":44518.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28810.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41685.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":41281.00,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":71397.90,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":74967.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":42495.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":42090.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43304.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":39257.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42495.15,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":42899.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":78919.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50589.46,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":42495.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":41078.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":41281.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":88296.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":38731.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40471.57,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":78919.56,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":40471.57,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":40471.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":41078.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39662.14,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":78919.56,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor IX (PTC or Christmas) ","code_information":[{"code":"85250","type":"CPT"},{"code":"L000202102","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.26,"maximum":39.98,"gross_charge":8.30,"discounted_cash":8.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.18,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.85,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":39.98,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":39.98,"methodology":"fee schedule"}]}]},{"description":"Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive techno ","code_information":[{"code":"97537","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.86,"maximum":64.81,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":64.81,"methodology":"fee schedule"}]}]},{"description":"CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; full gene sequence ","code_information":[{"code":"81189","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274.83,"maximum":577.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":313.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":577.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":577.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":577.14,"methodology":"fee schedule"}]}]},{"description":"Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants, comparative genomic ","code_information":[{"code":"81229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1160.00,"maximum":2436.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1276.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1241.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1229.60,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1229.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1183.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1183.20,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1322.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1276.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1241.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1276.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1241.20,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1183.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1392.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2436.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1334.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1165.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2436.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1218.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2436.00,"methodology":"fee schedule"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH MCC ","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":71737.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14317.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14739.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14879.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14458.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7652.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10295.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7652.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14177.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14177.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11603.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17984.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11603.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7652.29,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14879.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15440.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":71737.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":29700.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":71737.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14458.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14317.90,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24069.78,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":25273.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14739.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14598.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15019.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13616.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14739.02,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14879.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27372.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17546.45,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14739.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14247.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14317.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13433.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14037.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27372.46,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14037.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14037.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14247.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13756.42,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27372.46,"methodology":"fee schedule"}]}]},{"description":"DYSEQUILIBRIUM ","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":32749.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6865.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7067.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7134.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6932.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4818.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":6482.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4818.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6797.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6797.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7306.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":11323.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7306.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4818.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7134.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7403.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":32749.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13558.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32749.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6932.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6865.28,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10988.25,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":11537.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7067.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6999.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7201.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6528.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7067.20,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7134.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13124.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8413.33,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7067.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6831.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6865.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6441.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6730.66,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13124.79,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6730.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6730.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6831.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6596.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13124.79,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, ORTHOPEDIC, LENGTH OF STAY IS 13 DAYS OR ","code_information":[{"code":"128","type":"RC"},{"code":"A5101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12557.74,"maximum":14540.54,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13879.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14011.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12557.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14540.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13879.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12557.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12822.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12954.30,"methodology":"fee schedule"}]}]},{"description":"Factor xiii recomb a-subu ","code_information":[{"code":"1746","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":17.26,"maximum":36.24,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":36.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":36.24,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; alpha-2 antiplasmin ","code_information":[{"code":"85410","type":"CPT"},{"code":"L000207202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.98,"maximum":16.19,"gross_charge":33.10,"discounted_cash":33.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":16.19,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"158","type":"RC"},{"code":"A0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21532.80,"maximum":24932.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23799.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24026.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21532.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24932.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23799.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21532.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21986.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22212.78,"methodology":"fee schedule"}]}]},{"description":"FRACTURES OF FEMUR WITHOUT MCC ","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35658.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7421.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7639.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7712.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7494.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15135.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20362.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15135.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7348.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7348.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22951.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35570.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22951.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15135.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7712.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8003.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35658.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14763.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35658.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7494.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7421.35,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11964.33,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":12562.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7639.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7566.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7785.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7057.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7639.63,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7712.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":14187.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9094.80,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7639.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7384.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7421.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6962.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7275.84,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":14187.88,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7275.84,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7275.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7384.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7130.32,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":14187.88,"methodology":"fee schedule"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC ","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":23969.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5186.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5339.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5390.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5237.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6238.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8393.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6238.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5136.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5136.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9460.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14662.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9460.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6238.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5390.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5593.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":23969.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":9923.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":23969.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5237.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5186.99,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":8042.37,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":8444.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5339.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5288.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5441.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4932.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5339.55,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":5390.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9916.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6356.61,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":5339.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":5161.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5186.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4866.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5085.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9916.31,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5085.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5085.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5161.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4983.58,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9916.31,"methodology":"fee schedule"}]}]},{"description":"Grft, trnsmurl/trnsvens b ","code_information":[{"code":"2045","type":"APC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":26.62,"standard_charge_algorithm":"Reimbursement will be 26.62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_percentage":25.89,"standard_charge_algorithm":"Reimbursement will be 25.89% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_percentage":25.65,"standard_charge_algorithm":"Reimbursement will be 25.65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_percentage":25.65,"standard_charge_algorithm":"Reimbursement will be 25.65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":24.68,"standard_charge_algorithm":"Reimbursement will be 24.68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":24.68,"standard_charge_algorithm":"Reimbursement will be 24.68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_percentage":27.59,"standard_charge_algorithm":"Reimbursement will be 27.59% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_percentage":26.62,"standard_charge_algorithm":"Reimbursement will be 26.62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_percentage":25.89,"standard_charge_algorithm":"Reimbursement will be 25.89% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_percentage":26.62,"standard_charge_algorithm":"Reimbursement will be 26.62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_percentage":25.89,"standard_charge_algorithm":"Reimbursement will be 25.89% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_percentage":24.68,"standard_charge_algorithm":"Reimbursement will be 24.68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_percentage":29.04,"standard_charge_algorithm":"Reimbursement will be 29.04% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_percentage":50.82,"standard_charge_algorithm":"Reimbursement will be 50.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_percentage":27.83,"standard_charge_algorithm":"Reimbursement will be 27.83% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_percentage":24.32,"standard_charge_algorithm":"Reimbursement will be 24.32% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_percentage":50.82,"standard_charge_algorithm":"Reimbursement will be 50.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_percentage":25.41,"standard_charge_algorithm":"Reimbursement will be 25.41% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":50.82,"standard_charge_algorithm":"Reimbursement will be 50.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Hemoglobin; F (fetal), chemical ","code_information":[{"code":"83030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.74,"maximum":22.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":22.55,"methodology":"fee schedule"}]}]},{"description":"HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-A, -B, or -C), each ","code_information":[{"code":"81380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160.65,"maximum":372.23,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":194.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":189.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":187.89,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":187.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":180.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":180.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":202.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":194.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":189.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":194.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":189.66,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":180.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":160.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":212.70,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":372.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":178.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":372.23,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":186.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":372.23,"methodology":"fee schedule"}]}]},{"description":"HYPERTENSION WITH MCC ","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":51470.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10443.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10750.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10853.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10546.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6812.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9165.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6812.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10341.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10341.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10330.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16011.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10330.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6812.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10853.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11262.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":51470.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21309.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":51470.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10546.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10443.78,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17269.56,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":18133.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10750.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10648.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10955.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9931.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10750.95,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10853.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":19966.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12798.75,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10750.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10392.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10443.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9798.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10239.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":19966.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10239.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10239.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10392.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10034.22,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":19966.05,"methodology":"fee schedule"}]}]},{"description":"Implantation of Drug Infu ","code_information":[{"code":"5471","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":16417.36,"maximum":34476.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18059.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17566.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17402.40,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":17402.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16745.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16745.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18715.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18059.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17566.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18059.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17566.58,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16745.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19700.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":34476.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18879.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16499.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":34476.46,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17238.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16417.36,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":34476.46,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism ","code_information":[{"code":"87797","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.22,"maximum":63.06,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":31.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32.13,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":63.06,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":63.06,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, quantification ","code_information":[{"code":"87533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37.85,"maximum":87.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":45.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":44.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":42.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":42.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":47.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":45.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":45.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":44.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":42.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":37.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":50.11,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":87.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":48.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":41.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":87.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":87.70,"methodology":"fee schedule"}]}]},{"description":"Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion) ","code_information":[{"code":"87906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116.68,"maximum":270.33,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":141.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":137.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":136.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":136.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":131.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":131.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":146.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":141.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":137.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":141.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":137.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":131.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":116.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":154.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":270.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":148.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":129.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":270.33,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":135.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":270.33,"methodology":"fee schedule"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC ","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29367.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6218.75,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6401.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6462.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6279.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10573.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14224.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10573.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6157.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6157.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16033.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24848.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16033.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10573.16,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6462.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6706.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29367.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12158.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29367.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6279.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6218.75,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9853.41,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":10346.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6401.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6340.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6523.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5913.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6401.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6462.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11888.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7621.02,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6401.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6188.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6218.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5834.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6096.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11888.79,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6096.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6096.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6188.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5974.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11888.79,"methodology":"fee schedule"}]}]},{"description":"Inj pemetrexed, hospira 1 ","code_information":[{"code":"9123","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.62,"maximum":1.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":0.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.66,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":0.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.74,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1.30,"methodology":"fee schedule"}]}]},{"description":"Inj, nitroglycerin, 5 mg ","code_information":[{"code":"9404","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.41,"maximum":2.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2.96,"methodology":"fee schedule"}]}]},{"description":"Inj. lumasiran, 0.5 mg ","code_information":[{"code":"9407","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":317.88,"maximum":667.54,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":349.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":340.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":336.95,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":336.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":324.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":324.24,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":362.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":349.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":340.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":349.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":340.13,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":324.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":381.45,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":667.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":365.56,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":319.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":667.54,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":333.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":317.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":667.54,"methodology":"fee schedule"}]}]},{"description":"Injection, inclisiran, 1 ","code_information":[{"code":"9004","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":12.19,"maximum":25.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.59,"methodology":"fee schedule"}]}]},{"description":"Inst tauro 1.35mg/hep 100 ","code_information":[{"code":"744","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":8.58,"maximum":18.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.10,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.18,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.30,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18.02,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC ","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":44977.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9202.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9473.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9563.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9292.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15945.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":21453.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15945.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9112.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9112.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":24180.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":37475.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24180.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15945.94,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9563.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9924.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":44977.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":18621.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":44977.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9292.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9202.65,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15091.02,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":15845.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9473.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9383.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9653.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8751.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9473.31,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9563.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":17593.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11277.75,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9473.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9157.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9202.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":25006.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8634.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9022.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":17593.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9022.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9022.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9157.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8841.76,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":17593.30,"methodology":"fee schedule"}]}]},{"description":"Level 1 Breast/Lymphatic ","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3508.89,"maximum":7368.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3859.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3754.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3719.42,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3719.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3579.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3579.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4000.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3859.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3754.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3859.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3754.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3579.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4210.67,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":7368.67,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4035.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3526.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":7368.67,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3684.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3508.89,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":7368.67,"methodology":"fee schedule"}]}]},{"description":"Level 3 Electrophysiologi ","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21863.42,"maximum":45913.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24049.76,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23393.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23175.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":23175.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22300.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22300.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24924.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24049.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23393.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24049.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23393.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":22300.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26236.10,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":45913.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25142.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21972.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":45913.18,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22956.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":45913.18,"methodology":"fee schedule"}]}]},{"description":"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA ","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":167458.23,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32614.89,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33574.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33893.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":32934.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":34927.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46990.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":34927.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":32295.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32295.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":52963.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":82084.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":52963.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":34927.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33893.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35172.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":167458.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":69330.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":167458.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32934.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32614.89,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":56186.34,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":58995.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33574.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":33254.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34213.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31016.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33574.15,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":33893.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":62351.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39969.22,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":33574.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32455.01,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32614.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":70521.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30600.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31975.38,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":62351.99,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":31975.38,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":31975.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32455.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31335.87,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":62351.99,"methodology":"fee schedule"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC ","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":82607.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16395.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16877.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17038.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":46348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":21659.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":42555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16556.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11173.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15033.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11173.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16234.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16234.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16943.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26260.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16943.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11173.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17038.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17681.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":82607.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34201.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":82607.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16556.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16395.65,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27716.85,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":29102.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16877.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16717.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17199.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15591.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16877.88,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17038.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":31344.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20092.71,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16877.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16315.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16395.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26148.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15382.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16074.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":31344.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16074.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16074.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16315.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15752.69,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":31344.63,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"128","type":"RC"},{"code":"D1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19965.17,"maximum":23117.56,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22066.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22276.92,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19965.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21015.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23117.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21015.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22066.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19965.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20385.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21015.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21015.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21015.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20595.64,"methodology":"fee schedule"}]}]},{"description":"Oncology (lung cancer), four-probe FISH (3q29, 3p22.1, 10q22.3, 10cen) assay, whole blood, predictive algorithmgenerated evaluation reported as decreased or increased risk for lung cancer ","code_information":[{"code":"0317U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2030.00,"maximum":4263.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2233.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2172.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2151.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2151.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2070.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2070.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2314.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2233.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2172.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2233.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2172.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2070.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2436.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":4263.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2334.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2040.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":4263.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2131.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2030.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":4263.00,"methodology":"fee schedule"}]}]},{"description":"Oral methotrexate (jylamv ","code_information":[{"code":"755","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":19.36,"maximum":40.65,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.23,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":40.65,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M < 30.75 ","code_information":[{"code":"148","type":"RC"},{"code":"C1203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26429.34,"maximum":30602.40,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29211.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29489.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26429.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27820.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30602.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27820.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29211.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26429.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26985.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27820.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27820.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27820.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27263.96,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"148","type":"RC"},{"code":"D1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19128.76,"maximum":22149.09,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21142.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21343.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19128.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20135.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22149.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20135.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21142.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19128.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19531.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20135.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20135.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20135.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19732.83,"methodology":"fee schedule"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC ","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":53967.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10921.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11242.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11349.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11028.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8750.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11773.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8750.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10814.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10814.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13269.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20565.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13269.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8750.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11349.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11777.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":53967.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22343.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":53967.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11028.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10921.13,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18107.46,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":19012.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11242.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11135.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11456.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10385.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11242.34,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11349.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20878.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13383.74,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11242.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10867.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10921.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10246.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10706.99,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20878.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10706.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10706.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10867.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10492.85,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20878.63,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 34.35 & M < 44.75 ","code_information":[{"code":"128","type":"RC"},{"code":"C0902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20013.58,"maximum":23173.62,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22120.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22330.94,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20013.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21066.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23173.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21066.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22120.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20013.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20434.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21066.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21066.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21066.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20645.59,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"138","type":"RC"},{"code":"B1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31631.41,"maximum":36625.84,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":34961.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35293.99,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":31631.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33296.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36625.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33296.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":34961.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31631.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32297.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33296.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33296.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33296.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32630.29,"methodology":"fee schedule"}]}]},{"description":"Penicillin g benzathine i ","code_information":[{"code":"1829","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":24.37,"maximum":51.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.80,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":25.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":51.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":51.17,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":51.17,"methodology":"fee schedule"}]}]},{"description":"PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; single breakpoint (eg, intron 3, intron 6 or exon 6), qualitative o ","code_information":[{"code":"81316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207.31,"maximum":435.35,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":219.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":219.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":236.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":248.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":435.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":208.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":435.35,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":217.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":435.35,"methodology":"fee schedule"}]}]},{"description":"Pregnancy-associated plasma protein-A (PAPP-A) ","code_information":[{"code":"84163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.64,"maximum":31.61,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":31.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":31.61,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":31.61,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M < 29.15 ","code_information":[{"code":"118","type":"RC"},{"code":"B1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37970.38,"maximum":43965.70,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41967.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42366.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":37970.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":43965.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41967.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37970.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38769.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39968.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39169.44,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 49.25 ","code_information":[{"code":"148","type":"RC"},{"code":"A1501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15185.48,"maximum":17583.19,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16783.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16943.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15185.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17583.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16783.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15185.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15505.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15665.02,"methodology":"fee schedule"}]}]},{"description":"Ranibizumab injection ","code_information":[{"code":"9233","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":137.14,"maximum":287.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":150.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.36,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":145.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":156.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":139.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.56,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":287.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":287.99,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.14,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":287.99,"methodology":"fee schedule"}]}]},{"description":"RENAL FAILURE WITH CC ","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38944.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8049.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8286.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8365.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8128.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14143.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19029.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14143.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7970.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7970.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":21447.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":33240.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21447.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14143.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8365.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8680.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38944.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16123.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38944.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8128.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8049.46,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13066.83,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":13720.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8286.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8207.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8444.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7654.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8286.20,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8365.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":15388.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9864.53,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8286.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8010.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8049.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7552.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7891.62,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":15388.66,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7891.62,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7891.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8010.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7733.79,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":15388.66,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"148","type":"RC"},{"code":"D0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20991.89,"maximum":24306.40,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23201.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23422.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20991.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24306.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23201.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20991.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21433.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21654.79,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M < 26.15 ","code_information":[{"code":"158","type":"RC"},{"code":"C1303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23409.28,"maximum":27105.48,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25873.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26119.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23409.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24641.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27105.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24641.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25873.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23409.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23902.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24641.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24641.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24641.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24148.52,"methodology":"fee schedule"}]}]},{"description":"Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) ","code_information":[{"code":"77063","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.85,"maximum":47.31,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.88,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":23.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":47.31,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":47.31,"methodology":"fee schedule"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH CC ","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35925.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7472.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7692.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7765.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7545.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19403.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25773.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19403.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7399.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7399.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27715.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":29332.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27715.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19403.00,"methodology":"case rate"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7765.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8058.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35925.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14873.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35925.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7545.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7472.44,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12054.00,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":12656.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7692.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7618.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7838.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7106.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7692.22,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7765.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":14285.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9157.40,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7692.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7435.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7472.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7010.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7325.92,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":14285.55,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7325.92,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7325.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7435.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7179.40,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":14285.55,"methodology":"fee schedule"}]}]},{"description":"SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (eg, Prader-Willi syndrome and/or Angelman syndrome), methylation analysis ","code_information":[{"code":"81331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51.07,"maximum":107.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":54.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.09,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":58.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":52.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.28,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":107.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":107.25,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":107.25,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"118","type":"RC"},{"code":"A0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32220.73,"maximum":37308.21,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35612.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35951.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32220.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37308.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35612.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32220.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32899.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33916.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33238.22,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C > 18.5 ","code_information":[{"code":"148","type":"RC"},{"code":"B0102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20739.80,"maximum":24014.50,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22922.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23141.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20739.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21831.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24014.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21831.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22922.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20739.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21176.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21831.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21831.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21831.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21394.74,"methodology":"fee schedule"}]}]},{"description":"Theophylline ","code_information":[{"code":"80198","type":"CPT"},{"code":"L000006101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.81,"maximum":29.69,"gross_charge":623.85,"discounted_cash":623.85,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":29.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":29.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":29.69,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"158","type":"RC"},{"code":"B0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":44048.91,"maximum":51004.00,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":48685.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":49149.31,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":44048.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46367.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":51004.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":46367.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48685.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":44048.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44976.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46367.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":46367.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":46367.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":45439.93,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 53.35 & C > 23.5 ","code_information":[{"code":"118","type":"RC"},{"code":"D0201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12736.37,"maximum":14747.38,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14077.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14211.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12736.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13406.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14747.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13406.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14077.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12736.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13004.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13406.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13406.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13406.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13138.57,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"148","type":"RC"},{"code":"D0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34928.60,"maximum":40443.65,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":38605.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38972.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34928.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40443.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38605.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34928.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35663.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36766.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36031.61,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 48.45 ","code_information":[{"code":"128","type":"RC"},{"code":"D0401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17380.83,"maximum":20125.17,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19210.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19393.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17380.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18295.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20125.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18295.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19210.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17380.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17746.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18295.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18295.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18295.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17929.70,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC ","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":79658.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15832.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16297.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16452.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15987.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14521.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19537.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14521.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15676.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15676.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22020.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34128.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22020.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14521.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16452.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17073.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":79658.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":32980.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":79658.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15987.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15832.04,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":26727.54,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":28063.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16297.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16142.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16608.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15055.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16297.69,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16452.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30267.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19402.01,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16297.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15754.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15832.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29433.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14854.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15521.61,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30267.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15521.61,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15521.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15754.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15211.18,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30267.14,"methodology":"fee schedule"}]}]},{"description":"Volume measurement for timed collection, each ","code_information":[{"code":"81050","type":"CPT"},{"code":"L000042701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.30,"maximum":7.64,"gross_charge":93.55,"discounted_cash":93.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":7.64,"methodology":"fee schedule"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH CC ","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75076.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13808.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14214.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14350.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13944.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":31945.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":42978.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":31945.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13673.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13673.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":48441.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":75076.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":48441.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":31945.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14350.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14891.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":69074.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28597.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":69074.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13944.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13808.72,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23176.02,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":24334.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14214.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14079.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14485.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13131.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14214.86,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14350.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26399.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16922.45,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14214.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13741.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13808.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":34035.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12955.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13537.96,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26399.02,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13537.96,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13537.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13741.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13267.20,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26399.02,"methodology":"fee schedule"}]}]},{"description":"All potassium hydroxide (koh) preparations ","code_information":[{"code":"Q0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5.29,"maximum":12.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":12.24,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 47.65 ","code_information":[{"code":"118","type":"RC"},{"code":"C1001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16719.72,"maximum":19359.68,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18479.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18655.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16719.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17599.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19359.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17599.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18479.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16719.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17071.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17599.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17599.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17599.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17247.71,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"158","type":"RC"},{"code":"B1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26850.05,"maximum":31089.53,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29676.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29959.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26850.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31089.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29676.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26850.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27415.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27697.95,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M=12-37 ","code_information":[{"code":"138","type":"RC"},{"code":"C1103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26915.16,"maximum":31164.92,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29748.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30031.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26915.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28331.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31164.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28331.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29748.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26915.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27481.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28331.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28331.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28331.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27765.11,"methodology":"fee schedule"}]}]},{"description":"Antibody; Diphtheria ","code_information":[{"code":"86648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.78,"maximum":31.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":31.94,"methodology":"fee schedule"}]}]},{"description":"Antibody; Neisseria meningitidis ","code_information":[{"code":"86741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.95,"maximum":27.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.70,"methodology":"fee schedule"}]}]},{"description":"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC ","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":61545.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35447.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":61545.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":50157.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36489.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36837.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":86310.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":40336.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":79250.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":35794.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":26284.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":35362.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":26284.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35099.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35099.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":39857.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":61772.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":39857.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":26284.61,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36837.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38227.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35794.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35447.20,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":61157.88,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":64215.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36489.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":36142.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37184.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33709.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36489.77,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":36837.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":67766.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43440.20,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":36489.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35273.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35447.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":70920.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":33257.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34752.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":67766.71,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":34752.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":34752.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35273.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34057.12,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":67766.71,"methodology":"fee schedule"}]}]},{"description":"BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative ","code_information":[{"code":"81206","type":"CPT"},{"code":"L000048001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":163.96,"maximum":344.32,"gross_charge":703.60,"discounted_cash":703.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":175.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":173.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":173.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":186.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":175.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":175.44,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":196.75,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":344.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":188.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":164.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":344.32,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":172.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":344.32,"methodology":"fee schedule"}]}]},{"description":"Blood count; reticulocyte, automated ","code_information":[{"code":"85045","type":"CPT"},{"code":"L000199801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.62,"maximum":8.38,"gross_charge":438.25,"discounted_cash":438.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8.38,"methodology":"fee schedule"}]}]},{"description":"BURNS; M > 0 ","code_information":[{"code":"158","type":"RC"},{"code":"D2101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19090.36,"maximum":22104.63,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21099.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21300.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19090.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20095.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22104.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20095.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21099.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19090.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19492.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20095.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20095.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20095.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19693.22,"methodology":"fee schedule"}]}]},{"description":"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC ","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":43277.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4303.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4430.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4472.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4345.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18414.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24775.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18414.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4261.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4261.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27924.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":43277.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27924.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18414.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4472.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4640.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":19347.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":8010.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19347.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4345.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4303.46,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":6491.52,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":6816.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4430.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4387.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4514.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4092.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4430.04,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":4472.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8227.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5273.85,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":4430.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4282.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4303.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4037.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4219.08,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8227.21,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4219.08,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4219.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4282.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4134.70,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8227.21,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M < 31.15 ","code_information":[{"code":"158","type":"RC"},{"code":"D1404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26239.03,"maximum":30382.03,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29001.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29277.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26239.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27620.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30382.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27620.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29001.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26239.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26791.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27620.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27620.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27620.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27067.63,"methodology":"fee schedule"}]}]},{"description":"Chemotaxis assay, specify method ","code_information":[{"code":"86155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.49,"maximum":33.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":33.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":33.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":33.58,"methodology":"fee schedule"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC ","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":46865.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9563.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9844.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9938.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9657.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12489.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16803.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12489.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9469.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9469.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18939.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":29352.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18939.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12489.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9938.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10313.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46865.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19403.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":46865.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9657.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9563.60,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15724.59,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":16510.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9844.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9751.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10032.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9094.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9844.88,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9938.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18283.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11720.09,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9844.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9516.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9563.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8972.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9376.08,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18283.35,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9376.08,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9376.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9516.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9188.55,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18283.35,"methodology":"fee schedule"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC ","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":139979.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27362.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28167.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28435.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41567.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":19425.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":38165.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":27630.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":31784.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":42762.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":31784.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27094.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27094.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":48198.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":74698.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":48198.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":31784.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28435.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29508.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":139979.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":57954.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":139979.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27630.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27362.30,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":46966.50,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":49314.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28167.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27898.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28703.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26021.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28167.07,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":28435.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":52310.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33532.22,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":28167.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27228.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27362.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25672.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26825.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":52310.27,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26825.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26825.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27228.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26289.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":52310.27,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; other methods ","code_information":[{"code":"87158","type":"CPT"},{"code":"L000347101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.01,"maximum":16.25,"gross_charge":33.20,"discounted_cash":33.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":16.25,"methodology":"fee schedule"}]}]},{"description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection ","code_information":[{"code":"87166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.24,"maximum":23.73,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":23.73,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":23.73,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH CC ","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47509.73,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9686.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9971.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10066.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9781.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8324.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11199.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8324.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9591.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9591.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12623.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19564.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12623.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8324.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10066.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10446.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47509.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19669.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47509.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9781.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9686.70,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15940.68,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":16737.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9971.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9876.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10161.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9211.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9971.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10066.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18518.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11870.96,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9971.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9639.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9686.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9088.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9496.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18518.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9496.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9496.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9639.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9306.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18518.70,"methodology":"fee schedule"}]}]},{"description":"Epilepsy genomic sequence analysis panel, must include analyses for ALDH7A1, CACNA1A, CDKL5, CHD2, GABRG2, GRIN2A, KCNQ2, MECP2, PCDH19, POLG, PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1 ","code_information":[{"code":"81419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2448.56,"maximum":5141.98,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2693.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2619.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2595.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2595.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2791.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2693.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2619.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2693.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2619.96,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2938.27,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5141.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2815.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2460.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5141.98,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2570.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5141.98,"methodology":"fee schedule"}]}]},{"description":"Exome (ie, somatic mutations), paired formalin-fixed paraffin-embedded tumor tissue and normal specimen, sequence analyses ","code_information":[{"code":"0036U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4780.00,"maximum":10038.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5258.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5114.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5066.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5066.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4875.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4875.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5449.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5258.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5114.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5258.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5114.60,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4875.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5736.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10038.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5497.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4803.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10038.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5019.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4780.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10038.00,"methodology":"fee schedule"}]}]},{"description":"Fetal aneuploidy (trisomy 13, 18, and 21), DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy, includes sex reporting, if performed ","code_information":[{"code":"0327U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":795.00,"maximum":1669.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":874.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":842.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":842.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":810.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":810.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":906.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":874.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":874.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":810.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":954.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1669.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":914.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":798.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1669.50,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":834.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1669.50,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; plasmin ","code_information":[{"code":"85400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.98,"maximum":16.19,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":16.19,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"138","type":"RC"},{"code":"C0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24602.95,"maximum":28487.62,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27192.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27451.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24602.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25897.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28487.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25897.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27192.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24602.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25120.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25897.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25897.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25897.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25379.88,"methodology":"fee schedule"}]}]},{"description":"G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; full gene sequence ","code_information":[{"code":"81249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600.00,"maximum":1260.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":684.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":603.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"}]}]},{"description":"Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use ","code_information":[{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2.97,"maximum":6.89,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 35.95 ","code_information":[{"code":"128","type":"RC"},{"code":"A1901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12242.21,"maximum":14175.19,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13530.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13659.73,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12242.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12886.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14175.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12886.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13530.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12242.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12499.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12886.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12886.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12886.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12628.80,"methodology":"fee schedule"}]}]},{"description":"Hematology (heparin-induced thrombocytopenia), platelet antibody reactivity by flow cytometry, serum ","code_information":[{"code":"0275U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.37,"maximum":38.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":38.58,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITH MCC ","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":130822.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25611.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26365.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26616.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":25863.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":22135.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29780.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":22135.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25360.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25360.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":33566.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":52021.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":33566.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":22135.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26616.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27620.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":130822.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":54163.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":130822.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25863.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25611.99,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":43894.20,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":46088.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26365.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":26114.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26867.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24356.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26365.28,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":26616.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":48964.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31387.24,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":26365.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25486.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25611.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24030.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25109.79,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":48964.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":25109.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":25109.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25486.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24607.59,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":48964.09,"methodology":"fee schedule"}]}]},{"description":"I131 iodide sol, rx ","code_information":[{"code":"1150","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":20.40,"maximum":42.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.83,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.40,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.48,"maximum":26.59,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26.59,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed ","code_information":[{"code":"87521","type":"CPT"},{"code":"L000367702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":73.69,"gross_charge":106.50,"discounted_cash":106.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":40.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":73.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":73.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":73.69,"methodology":"fee schedule"}]}]},{"description":"Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic alg ","code_information":[{"code":"81596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72.19,"maximum":151.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":79.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":77.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":76.52,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":76.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":73.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":73.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":82.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":79.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":77.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":79.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":77.24,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":73.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":86.63,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":151.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":83.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":72.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":151.60,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":75.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":72.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":151.60,"methodology":"fee schedule"}]}]},{"description":"Inj glucagon hcl, freseni ","code_information":[{"code":"9025","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":108.92,"maximum":228.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":119.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":116.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":115.46,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":115.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":111.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":111.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":124.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":119.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":116.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":119.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":116.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":111.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":130.71,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":228.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":125.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":109.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":228.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":114.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":108.92,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":228.74,"methodology":"fee schedule"}]}]},{"description":"Inj, aspara, rylaze, 0.1 ","code_information":[{"code":"9437","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":52.79,"maximum":110.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":56.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":53.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":53.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":60.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":56.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":56.48,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":53.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":63.35,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":110.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":60.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":53.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":110.85,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":55.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":52.79,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":110.85,"methodology":"fee schedule"}]}]},{"description":"Inj, lenacapavir, 1 mg ","code_information":[{"code":"9155","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21.99,"maximum":46.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":46.19,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":46.19,"methodology":"fee schedule"}]}]},{"description":"Inj. (ani), up to 40 unit ","code_information":[{"code":"9275","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3416.97,"maximum":7175.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3758.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3656.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3621.99,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3621.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3485.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3485.31,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3895.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3758.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3656.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3758.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3656.16,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3485.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4100.37,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":7175.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3929.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3434.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":7175.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3587.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":7175.64,"methodology":"fee schedule"}]}]},{"description":"Injection, bortezomib, 0. ","code_information":[{"code":"9207","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.57,"maximum":3.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3.30,"methodology":"fee schedule"}]}]},{"description":"Intensive Outpatient (3 s ","code_information":[{"code":"5861","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":250.36,"maximum":525.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":265.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":265.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":285.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":300.43,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":525.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":287.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":251.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":525.76,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":262.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":525.76,"methodology":"fee schedule"}]}]},{"description":"Leuprolide acetate injeci ","code_information":[{"code":"9047","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":9.20,"maximum":19.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":19.33,"methodology":"fee schedule"}]}]},{"description":"Level 2 Urology and Relat ","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":628.83,"maximum":1320.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":691.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":672.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":666.56,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":666.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":641.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":641.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":716.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":691.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":672.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":691.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":672.85,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":641.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":754.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1320.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":723.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":631.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1320.55,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":660.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1320.55,"methodology":"fee schedule"}]}]},{"description":"Level 4 Neurostimulator a ","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":20137.52,"maximum":42288.79,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22151.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21547.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21345.77,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21345.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20540.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20540.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22956.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22151.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21547.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22151.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21547.15,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20540.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24165.02,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42288.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23158.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20238.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42288.79,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21144.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42288.79,"methodology":"fee schedule"}]}]},{"description":"Lutetium lu 177 vipivotid ","code_information":[{"code":"9054","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":241.24,"maximum":506.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":258.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":255.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":255.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":246.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":246.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":275.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":258.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":265.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":258.13,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":246.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":289.49,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":506.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":277.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":242.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":506.60,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":253.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":241.24,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":506.60,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA W BRAIN OR SPINAL CORD INJURY; M > ","code_information":[{"code":"118","type":"RC"},{"code":"C1802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18945.12,"maximum":21936.46,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20939.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21138.77,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18945.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19942.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21936.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19942.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20939.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18945.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19343.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19942.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19942.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19942.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19543.39,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"128","type":"RC"},{"code":"D1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25269.06,"maximum":29258.92,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27928.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28194.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25269.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26599.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29258.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26599.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27928.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25269.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25801.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26599.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26599.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26599.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26067.03,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA,NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"158","type":"RC"},{"code":"C1704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28993.65,"maximum":33571.59,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32045.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32350.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28993.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33571.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32045.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28993.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29604.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29909.24,"methodology":"fee schedule"}]}]},{"description":"Minocycline hydrochloride ","code_information":[{"code":"1853","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.59,"maximum":5.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5.43,"methodology":"fee schedule"}]}]},{"description":" Emergency Room ER Beyond EMTALA  ","code_information":[{"code":"452","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":700.00,"maximum":4000.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2592.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":739.00,"methodology":"case rate"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":845.00,"methodology":"case rate"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":825.00,"methodology":"case rate"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":2426.00,"methodology":"case rate"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":745.00,"methodology":"case rate"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":745.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":2426.00,"methodology":"case rate"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":850.00,"methodology":"case rate"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":800.00,"methodology":"case rate"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":700.00,"methodology":"case rate"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":783.00,"methodology":"case rate"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4000.00,"methodology":"case rate"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"case rate"}]}]},{"description":"Albumin (human), 25%, 20 ","code_information":[{"code":"964","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21.23,"maximum":44.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.50,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":22.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":44.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":44.59,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 48.85 ","code_information":[{"code":"148","type":"RC"},{"code":"A1401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12697.97,"maximum":14702.91,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14034.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14168.26,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12697.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14702.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14034.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12697.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12965.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13098.96,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; additional cells counted, each study ","code_information":[{"code":"88285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.39,"maximum":56.51,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.29,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":56.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":56.51,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":56.51,"methodology":"fee schedule"}]}]},{"description":"Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte ","code_information":[{"code":"85397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.97,"maximum":64.81,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":64.81,"methodology":"fee schedule"}]}]},{"description":"Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score ","code_information":[{"code":"81493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1050.00,"maximum":2205.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1155.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1123.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1113.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1113.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1071.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1071.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1197.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1155.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1123.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1155.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1123.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1071.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2205.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1207.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1055.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2205.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1102.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2205.00,"methodology":"fee schedule"}]}]},{"description":"CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, full gene sequence (List separately in addition to code for primary procedure) ","code_information":[{"code":"0071U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600.00,"maximum":1260.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":684.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":603.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"}]}]},{"description":"DIABETES WITHOUT CC/MCC ","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":27452.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5852.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6024.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6082.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5910.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7981.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10737.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7981.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5795.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5795.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12102.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18756.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12102.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7981.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6082.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6311.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":27452.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":11365.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":27452.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5910.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5852.78,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9211.02,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":9671.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6024.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5967.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6139.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5565.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6024.92,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6082.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11189.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7172.52,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6024.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":5824.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5852.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5491.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5738.02,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11189.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5738.02,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5738.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5824.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5623.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11189.14,"methodology":"fee schedule"}]}]},{"description":"Elastase, pancreatic (EL-1), fecal; qualitative or semi-quantitative ","code_information":[{"code":"82656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.45,"maximum":24.21,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":24.21,"methodology":"fee schedule"}]}]},{"description":"Etoposide oral ","code_information":[{"code":"802","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":76.66,"maximum":160.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":84.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":82.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":81.26,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":81.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":78.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":78.20,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":87.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":84.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":82.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":84.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":82.03,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":78.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":92.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":160.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":88.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":77.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":160.99,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":80.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":76.66,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":160.99,"methodology":"fee schedule"}]}]},{"description":"Factor inhibitor test ","code_information":[{"code":"85335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.67,"maximum":27.03,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.03,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.03,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; plasminogen activator ","code_information":[{"code":"85415","type":"CPT"},{"code":"L000207302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.58,"maximum":36.10,"gross_charge":35.15,"discounted_cash":35.15,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":36.10,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"148","type":"RC"},{"code":"D0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23305.77,"maximum":26985.63,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25759.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26004.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23305.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26985.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25759.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23305.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23796.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24041.74,"methodology":"fee schedule"}]}]},{"description":"Gammaglobulin (immunoglobulin); IgE ","code_information":[{"code":"82785","type":"CPT"},{"code":"L000116002","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.92,"maximum":34.57,"gross_charge":135.70,"discounted_cash":135.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":34.57,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":34.57,"methodology":"fee schedule"}]}]},{"description":"Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4) ","code_information":[{"code":"80428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.45,"maximum":140.07,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":71.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":70.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":70.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":68.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":68.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":76.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":71.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":73.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":71.37,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":68.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":60.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":80.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":140.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":76.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":67.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":140.07,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":70.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":66.70,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":140.07,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 35.95 ","code_information":[{"code":"118","type":"RC"},{"code":"B1901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17365.80,"maximum":20107.77,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19193.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19376.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17365.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18279.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20107.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18279.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19193.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17365.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17731.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18279.79,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18279.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18279.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17914.20,"methodology":"fee schedule"}]}]},{"description":"HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE) ","code_information":[{"code":"81361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":174.81,"maximum":367.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.30,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":185.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":199.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":209.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":367.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":201.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":175.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":367.10,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":183.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":367.10,"methodology":"fee schedule"}]}]},{"description":"Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), genomic sequence analysis panel, must include sequencing of at lea ","code_information":[{"code":"81439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584.90,"maximum":1228.29,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":619.99,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":619.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":666.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":701.88,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1228.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":587.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1228.29,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":614.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1228.29,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 ","code_information":[{"code":"81378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":313.21,"maximum":725.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":369.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":366.30,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":366.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":352.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":352.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":393.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":369.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":369.76,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":352.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":313.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":414.68,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":725.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":397.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":347.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":725.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":362.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":725.70,"methodology":"fee schedule"}]}]},{"description":"Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration ","code_information":[{"code":"86325","type":"CPT"},{"code":"L000257702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":20.96,"maximum":48.57,"gross_charge":183.70,"discounted_cash":183.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":48.57,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":48.57,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; adenovirus ","code_information":[{"code":"87260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.08,"maximum":30.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30.30,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique ","code_information":[{"code":"87528","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.17,"maximum":42.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.06,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42.11,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease ºCOVID-19»), amplified probe technique ","code_information":[{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46.50,"maximum":107.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":46.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.57,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":107.75,"methodology":"fee schedule"}]}]},{"description":"Inj enfort vedo-ejfv 0.25 ","code_information":[{"code":"9364","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":36.74,"maximum":77.16,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":41.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":44.09,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":77.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":77.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":77.16,"methodology":"fee schedule"}]}]},{"description":"Inj rituximab, hyaluronid ","code_information":[{"code":"9467","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":36.94,"maximum":77.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.16,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":39.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39.53,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":37.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":44.33,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":77.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":77.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":77.58,"methodology":"fee schedule"}]}]},{"description":"Inj, durolane 1 mg ","code_information":[{"code":"9174","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":7.00,"maximum":14.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":14.70,"methodology":"fee schedule"}]}]},{"description":"Inj, tebentafusp-tebn, 1 ","code_information":[{"code":"9446","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":214.76,"maximum":450.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":236.23,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":227.64,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":227.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":244.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":236.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":236.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":257.71,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":246.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":215.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":450.99,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":225.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":450.99,"methodology":"fee schedule"}]}]},{"description":"Inj., cemiplimab-rwlc, 1 ","code_information":[{"code":"9304","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":28.24,"maximum":59.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33.89,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":59.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":59.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":59.30,"methodology":"fee schedule"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC ","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":82550.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16384.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16866.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17027.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16545.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11900.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16011.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11900.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16224.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16224.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18046.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27968.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18046.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11900.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17027.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17669.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":82550.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34177.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":82550.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16545.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16384.77,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27697.74,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":29082.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16866.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16706.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17187.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15581.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16866.67,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17027.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":31323.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20079.38,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16866.67,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16304.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16384.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15372.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16063.50,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":31323.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16063.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16063.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16304.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15742.23,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":31323.83,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC ","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":30304.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6397.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6586.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6648.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6460.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5900.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7938.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5900.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6335.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6335.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8947.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":13867.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8947.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5900.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6648.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6899.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":30304.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12546.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":30304.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6460.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6397.97,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10167.99,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":10676.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6586.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6523.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6711.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6084.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6586.14,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6648.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":12231.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7840.65,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6586.14,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6366.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6397.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6002.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6272.52,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":12231.41,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6272.52,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6272.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6366.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6147.07,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":12231.41,"methodology":"fee schedule"}]}]},{"description":"Level 2 Blood Product Exc ","code_information":[{"code":"5242","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1412.42,"maximum":2966.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1553.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1497.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1497.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1440.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1440.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1610.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1553.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1553.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1511.29,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1440.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1694.90,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2966.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1624.28,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1419.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2966.08,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1483.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1412.42,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2966.08,"methodology":"fee schedule"}]}]},{"description":"Level 3 Excision/ Biopsy/ ","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2615.73,"maximum":5493.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2877.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2798.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2772.68,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2772.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2668.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2668.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2981.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2877.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2798.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2877.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2798.83,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2668.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3138.88,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5493.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3008.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2628.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5493.04,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2746.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5493.04,"methodology":"fee schedule"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT ","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":154231.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30086.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30971.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31266.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":30381.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19470.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26195.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19470.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29791.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29791.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29525.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":45758.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29525.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19470.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":31266.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32446.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":154231.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":63854.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":154231.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30381.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30086.57,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":51748.41,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":54335.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30971.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":30676.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31561.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28611.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30971.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":31266.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":57518.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36870.80,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":30971.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29939.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30086.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":56225.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28228.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29496.64,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":57518.45,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":29496.64,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":29496.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29939.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28906.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":57518.45,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA W BRAIN OR SPINAL CORD INJURY; M > ","code_information":[{"code":"158","type":"RC"},{"code":"B1802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23748.18,"maximum":27497.89,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26247.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26497.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23748.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24998.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27497.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24998.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26247.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23748.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24248.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24998.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24998.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24998.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24498.12,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"158","type":"RC"},{"code":"B1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33365.98,"maximum":38634.30,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36878.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37229.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33365.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38634.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36878.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33365.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34068.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34419.65,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"148","type":"RC"},{"code":"D1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23108.77,"maximum":26757.53,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25541.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25784.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23108.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26757.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25541.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23108.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23595.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23838.52,"methodology":"fee schedule"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC ","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":65244.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13076.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13461.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13589.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13204.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15052.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20251.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15052.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12948.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12948.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22826.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35376.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22826.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15052.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13589.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14102.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":65244.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":27012.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":65244.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13204.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13076.78,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":21891.24,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":22985.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13461.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13333.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13717.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12435.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13461.39,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13589.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":24999.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16025.46,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13461.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13012.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13076.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12269.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12820.37,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":24999.72,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12820.37,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12820.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13012.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12563.96,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":24999.72,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 27.85 & M < 38.75 ","code_information":[{"code":"148","type":"RC"},{"code":"A2003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19983.53,"maximum":23138.82,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22087.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22297.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19983.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21035.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23138.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21035.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22087.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19983.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20404.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21035.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21035.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21035.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20614.59,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 49.15 ","code_information":[{"code":"138","type":"RC"},{"code":"D2001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14704.67,"maximum":17026.46,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16252.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16407.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14704.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15478.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17026.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15478.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16252.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14704.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15014.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15478.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15478.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15478.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15169.03,"methodology":"fee schedule"}]}]},{"description":"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R) ","code_information":[{"code":"81338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150.33,"maximum":315.69,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":160.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":159.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":153.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":153.34,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":171.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":160.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":160.85,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":153.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":180.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":315.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":172.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":151.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":315.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":157.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":150.33,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":315.69,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 25.85 & M < 37.35 ","code_information":[{"code":"148","type":"RC"},{"code":"D0603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23170.54,"maximum":26829.05,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25609.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25853.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23170.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26829.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25609.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23170.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23658.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23902.24,"methodology":"fee schedule"}]}]},{"description":"Neuropsychiatry (eg, depression, anxiety), genomic sequence analysis panel, variant analysis of 13 genes, saliva or buccal swab, report of each gene phenotype ","code_information":[{"code":"0419U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1336.09,"maximum":2805.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1469.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1429.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1416.26,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1416.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1362.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1362.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1523.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1469.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1429.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1469.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1429.62,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1362.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1603.31,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2805.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1536.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1342.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2805.79,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1402.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1336.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2805.79,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 18 ","code_information":[{"code":"1555","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1594.65,"maximum":3348.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1754.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1706.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1690.33,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1690.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1626.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1626.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1817.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1754.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1706.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1754.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1706.27,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1626.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1913.58,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3348.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1833.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1602.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3348.76,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1674.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1594.65,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3348.76,"methodology":"fee schedule"}]}]},{"description":"Nivestym ","code_information":[{"code":"9193","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.27,"maximum":0.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.29,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.32,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":0.57,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"158","type":"RC"},{"code":"C0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16010.20,"maximum":18538.12,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17695.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17864.01,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16010.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16852.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18538.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16852.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17695.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16010.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16347.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16852.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16852.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16852.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16515.78,"methodology":"fee schedule"}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":56543.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11413.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11749.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11861.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11525.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":13129.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":17664.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":13129.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11301.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11301.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":19910.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":30857.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":19910.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":13129.99,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11861.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12308.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":56543.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23410.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":56543.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11525.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11413.57,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18971.82,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":19920.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11749.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11637.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11973.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10854.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11749.26,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11861.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21820.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13987.21,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11749.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11357.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11413.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22639.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10708.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11189.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21820.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11189.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11189.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11357.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10965.97,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21820.05,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M < 27.85 ","code_information":[{"code":"128","type":"RC"},{"code":"B2004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35180.69,"maximum":40735.54,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":38883.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39254.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35180.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40735.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38883.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35180.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35921.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36291.66,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"148","type":"RC"},{"code":"C2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19626.26,"maximum":22725.15,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21692.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21898.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19626.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20659.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22725.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20659.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21692.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19626.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20039.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20659.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20659.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20659.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20246.04,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis ","code_information":[{"code":"81288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192.32,"maximum":403.87,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":211.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":205.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":203.86,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":203.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":219.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":211.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":205.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":211.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":205.78,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":230.78,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":403.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":221.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":193.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":403.87,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":201.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":403.87,"methodology":"fee schedule"}]}]},{"description":"Mycophenolate (mycophenolic acid) ","code_information":[{"code":"80180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.36,"maximum":37.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":37.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":37.91,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 37.35 & M < 47.75 ","code_information":[{"code":"128","type":"RC"},{"code":"A0602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17734.76,"maximum":20534.98,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19601.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19788.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17734.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18668.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20534.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18668.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19601.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17734.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18108.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18668.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18668.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18668.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18294.80,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"118","type":"RC"},{"code":"C0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16607.87,"maximum":19230.16,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18356.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18530.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16607.87,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17481.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19230.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17481.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18356.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16607.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16957.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17481.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17481.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17481.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17132.32,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 22 ","code_information":[{"code":"1559","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2174.34,"maximum":4566.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2391.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2326.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2304.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2304.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2217.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2217.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2478.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2391.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2326.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2391.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2326.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2217.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2609.21,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":4566.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2500.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2185.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":4566.12,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2283.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2174.34,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":4566.12,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 4 ","code_information":[{"code":"1504","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":242.02,"maximum":508.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":266.23,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":258.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":256.54,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":256.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":246.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":246.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":275.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":266.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":258.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":266.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":258.96,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":246.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":290.43,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":508.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":278.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":243.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":508.25,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":254.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":242.02,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":508.25,"methodology":"fee schedule"}]}]},{"description":"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC ","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":61038.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12272.80,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12633.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12754.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12393.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15082.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20292.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15082.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12152.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12152.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22871.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35447.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22871.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15082.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12754.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13235.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":61038.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":25271.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":61038.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12393.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12272.80,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20480.04,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":21504.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12633.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12513.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12874.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11671.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12633.77,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12754.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":23462.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15040.20,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12633.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12212.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12272.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11514.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12032.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":23462.71,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12032.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12032.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12212.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11791.52,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":23462.71,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M < 26.15 ","code_information":[{"code":"148","type":"RC"},{"code":"D0304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26527.84,"maximum":30716.45,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29320.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29599.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26527.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27924.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30716.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27924.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29320.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26527.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27086.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27924.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27924.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27924.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27365.56,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 23.75 & M < 2 ","code_information":[{"code":"118","type":"RC"},{"code":"B0505","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":50356.16,"maximum":58307.13,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":55656.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":56186.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":50356.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":53006.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":58307.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":53006.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":55656.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50356.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51416.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":53006.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":53006.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53006.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51946.35,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"118","type":"RC"},{"code":"D0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22405.93,"maximum":25943.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24764.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25000.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22405.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23585.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25943.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23585.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24764.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22405.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22877.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23585.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23585.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23585.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23113.48,"methodology":"fee schedule"}]}]},{"description":"NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid tumors) translocation analysis ","code_information":[{"code":"81191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":207.31,"maximum":435.35,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":219.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":219.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":236.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":248.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":435.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":208.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":435.35,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":217.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":435.35,"methodology":"fee schedule"}]}]},{"description":"Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR amplification of exons 12-14 and sequence analysis, blood or bone marrow, report of JAK2 mutation not detected or detected ","code_information":[{"code":"0017U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.66,"maximum":192.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":100.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":98.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":97.16,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":97.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":93.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":93.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":104.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":100.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":98.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":100.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":98.08,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":93.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":109.99,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":192.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":105.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":92.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":192.49,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":96.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":91.66,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":192.49,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid tumor), mass spectrometric 30 protein targets, formalin-fixed paraffin-embedded tissue, prognostic and predictive algorithm reported as likely, unlikely, or uncertain benefit of 39 che ","code_information":[{"code":"0174U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1305.37,"maximum":2741.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1435.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1396.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1383.69,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1383.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1331.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1331.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1488.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1435.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1396.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1435.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1396.75,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1331.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1566.44,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2741.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1501.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1311.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2741.28,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1370.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2741.28,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"138","type":"RC"},{"code":"B1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26835.03,"maximum":31072.13,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29659.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29942.24,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26835.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28247.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31072.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28247.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29659.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26835.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27399.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28247.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28247.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28247.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27682.45,"methodology":"fee schedule"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC ","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":144654.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28255.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29086.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29363.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":34533.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":16139.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":31709.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28532.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12439.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16735.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12439.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27978.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27978.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18862.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":29234.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18862.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12439.39,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29363.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":30472.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":144654.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":59889.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":144654.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28532.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28255.87,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":48534.99,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":50961.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29086.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":28809.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29640.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26870.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29086.92,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":29363.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":54018.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":34627.29,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":29086.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28117.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28255.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26510.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27701.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":54018.57,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":27701.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":27701.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28117.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27147.79,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":54018.57,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC ","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":48434.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9863.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10153.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10250.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9960.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11658.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15685.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11658.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9766.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9766.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17679.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27399.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17679.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11658.85,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10250.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10637.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48434.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20052.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48434.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9960.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9863.41,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16250.85,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":17063.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10153.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10056.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10346.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9379.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10153.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10250.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18856.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12087.51,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10153.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9815.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9863.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9254.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9670.01,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18856.52,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9670.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9670.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9815.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9476.61,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18856.52,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 34.35 & M < 44.75 ","code_information":[{"code":"158","type":"RC"},{"code":"D0902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18652.96,"maximum":21598.17,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20616.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20812.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18652.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19634.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21598.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19634.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20616.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18652.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19045.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19634.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19634.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19634.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19242.00,"methodology":"fee schedule"}]}]},{"description":"Pain management (opioid-use disorder) genotyping panel, 16 common variants (ie, ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or othe ","code_information":[{"code":"0078U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.91,"maximum":946.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":514.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":541.09,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":518.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":453.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":473.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"}]}]},{"description":"Partial Hospitalization ( ","code_information":[{"code":"5863","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":250.36,"maximum":525.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":265.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":265.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":285.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":300.43,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":525.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":287.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":251.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":525.76,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":262.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":525.76,"methodology":"fee schedule"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH CC ","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52886.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":29292.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9570.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":29292.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":23873.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9851.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9945.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":22410.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9664.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8834.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11885.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8834.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9476.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9476.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13396.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20761.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13396.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8834.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9945.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10320.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52886.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21896.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52886.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9664.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9570.30,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15736.35,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":16523.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9851.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9757.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10039.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9101.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9851.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9945.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18296.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11728.31,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9851.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9523.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9570.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":18151.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8979.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9382.64,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18296.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9382.64,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9382.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9523.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9194.99,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18296.16,"methodology":"fee schedule"}]}]},{"description":"Platelets, each unit ","code_information":[{"code":"9515","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":65.04,"maximum":136.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":74.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":136.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":74.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":65.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":136.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":68.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":136.58,"methodology":"fee schedule"}]}]},{"description":"Proinsulin ","code_information":[{"code":"84206","type":"CPT"},{"code":"L000183302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.19,"maximum":56.05,"gross_charge":49.10,"discounted_cash":49.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.03,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":56.05,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 29.15 & M < 39.05 ","code_information":[{"code":"148","type":"RC"},{"code":"B1503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30661.45,"maximum":35502.73,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33888.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34211.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30661.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35502.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33888.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30661.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31306.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31629.70,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 49.25 ","code_information":[{"code":"158","type":"RC"},{"code":"A1501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15185.48,"maximum":17583.19,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16783.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16943.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15185.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17583.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16783.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15185.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15505.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15984.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15665.02,"methodology":"fee schedule"}]}]},{"description":"Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups, utilizing whole blood, common RBC alleles reported ","code_information":[{"code":"0001U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":652.59,"maximum":1512.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":770.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":763.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":763.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":820.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":770.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":770.40,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":652.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":864.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1512.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":828.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":723.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1512.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":756.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1512.00,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"138","type":"RC"},{"code":"A0803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17475.99,"maximum":20235.36,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19315.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19499.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17475.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18395.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20235.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18395.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19315.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17475.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17843.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18395.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18395.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18395.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18027.86,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"148","type":"RC"},{"code":"A0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":13848.24,"maximum":16034.80,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15305.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15451.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13848.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14577.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16034.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14577.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15305.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13848.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14139.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14577.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14577.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14577.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14285.55,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M < 26.15 ","code_information":[{"code":"128","type":"RC"},{"code":"D1303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22344.16,"maximum":25872.18,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24696.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24931.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22344.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23520.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25872.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23520.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24696.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22344.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22814.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23520.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23520.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23520.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23049.76,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 36.35 ","code_information":[{"code":"118","type":"RC"},{"code":"B1301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18205.55,"maximum":21080.11,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20121.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20313.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18205.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21080.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20121.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18205.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18588.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18780.46,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"148","type":"RC"},{"code":"D1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28217.34,"maximum":32672.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31187.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31484.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28217.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32672.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31187.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28217.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28811.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29108.42,"methodology":"fee schedule"}]}]},{"description":"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC ","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":58992.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11881.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12231.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12347.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11998.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6202.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8344.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6202.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11765.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11765.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9405.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14576.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9405.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6202.57,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12347.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12813.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":58992.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24424.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":58992.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11998.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11881.70,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19793.55,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":20783.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12231.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12114.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12464.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11299.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12231.17,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12347.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":22715.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14560.91,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12231.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11823.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11881.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11147.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11648.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":22715.02,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11648.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11648.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11823.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11415.76,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":22715.02,"methodology":"fee schedule"}]}]},{"description":"SPINAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":97490.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":44399.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19240.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":44399.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":36183.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19806.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19995.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":29603.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":19429.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15505.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20861.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15505.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19051.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19051.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":23512.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":36441.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23512.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15505.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19995.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20749.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":97490.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":40362.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":97490.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19429.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19240.54,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":32710.44,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":34345.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19806.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19617.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20183.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18297.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19806.43,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19995.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":36783.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23579.09,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19806.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19146.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19240.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":33482.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18052.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18863.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":36783.38,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18863.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18863.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19146.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18486.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":36783.38,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"158","type":"RC"},{"code":"D0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27037.03,"maximum":31306.04,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29883.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30167.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27037.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31306.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29883.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27037.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27606.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27890.83,"methodology":"fee schedule"}]}]},{"description":"Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent ","code_information":[{"code":"87188","type":"CPT"},{"code":"L000349702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.01,"maximum":13.94,"gross_charge":28.50,"discounted_cash":28.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13.94,"methodology":"fee schedule"}]}]},{"description":"Testosterone; total ","code_information":[{"code":"84403","type":"CPT"},{"code":"L000189602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":23.40,"maximum":54.20,"gross_charge":211.60,"discounted_cash":211.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.62,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":26.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":23.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":54.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":54.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":54.20,"methodology":"fee schedule"}]}]},{"description":"Transferase; alanine amino (ALT) (SGPT) ","code_information":[{"code":"84460","type":"CPT"},{"code":"L000191501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.80,"maximum":11.13,"gross_charge":1206.15,"discounted_cash":1206.15,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11.13,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"148","type":"RC"},{"code":"C0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28324.19,"maximum":32796.43,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31305.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31603.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28324.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29814.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32796.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29814.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31305.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28324.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28920.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29814.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29814.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29814.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29218.64,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 53.35 & C > 23.5 ","code_information":[{"code":"118","type":"RC"},{"code":"C0201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14021.86,"maximum":16235.84,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15497.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15645.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14021.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14759.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16235.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14759.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15497.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14021.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14317.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14759.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14759.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14759.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14464.66,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"148","type":"RC"},{"code":"B0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25966.90,"maximum":30066.94,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28700.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28973.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25966.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27333.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30066.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27333.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28700.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25966.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26513.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27333.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27333.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27333.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26786.91,"methodology":"fee schedule"}]}]},{"description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual ","code_information":[{"code":"92507","type":"CPT"},{"code":"T000006302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":72.54,"maximum":157.04,"gross_charge":447.55,"discounted_cash":447.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":82.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":80.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":79.27,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":79.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":85.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":82.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":80.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":82.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":80.01,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":76.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":72.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":89.74,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":157.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":86.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":75.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":157.04,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":78.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":74.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":157.04,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC ","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":87549.52,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17340.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17850.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18020.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":17510.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":22594.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":30398.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":22594.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17170.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17170.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":34262.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":53101.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":34262.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":22594.98,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18020.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18700.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":87549.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":36247.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":87549.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17510.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17340.32,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":29375.01,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":30843.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17850.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17680.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18190.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16490.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17850.33,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18020.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":33150.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21250.39,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17850.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17255.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17340.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16269.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17000.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":33150.60,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17000.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17000.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17255.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16660.30,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":33150.60,"methodology":"fee schedule"}]}]},{"description":"Wheelchair management (eg, assessment, fitting, training), each 15 minutes ","code_information":[{"code":"97542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29.93,"maximum":64.81,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.03,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":64.81,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":64.81,"methodology":"fee schedule"}]}]},{"description":"Acetylcholinesterase ","code_information":[{"code":"82013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.14,"maximum":25.81,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.81,"methodology":"fee schedule"}]}]},{"description":"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA ","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":15449.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5831.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6003.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6060.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5889.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4182.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":5626.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4182.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5774.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5774.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6341.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":9828.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6341.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4182.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6060.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6289.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5889.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5831.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6003.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5946.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6117.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5545.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6003.37,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6060.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11149.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7146.86,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6003.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":5803.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5831.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5471.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5717.49,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11149.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5717.49,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5717.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5803.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5603.14,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11149.11,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 36.25 & M < 47.65 ","code_information":[{"code":"148","type":"RC"},{"code":"A1002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17334.08,"maximum":20071.04,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19158.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19341.19,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17334.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20071.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19158.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17334.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17699.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17881.48,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"148","type":"RC"},{"code":"B1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26850.05,"maximum":31089.53,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29676.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29959.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26850.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31089.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29676.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26850.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27415.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27697.95,"methodology":"fee schedule"}]}]},{"description":"Anacaulase-bcdb 8.8% gel ","code_information":[{"code":"742","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":58.34,"maximum":122.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":64.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":62.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":61.84,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":61.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":59.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":59.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":64.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":62.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":64.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":62.42,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":59.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":122.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":67.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":122.51,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":61.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":58.34,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":122.51,"methodology":"fee schedule"}]}]},{"description":"Antibody; Chlamydia, IgM ","code_information":[{"code":"86632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.49,"maximum":26.63,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26.63,"methodology":"fee schedule"}]}]},{"description":"Antibody; West Nile virus ","code_information":[{"code":"86789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.05,"maximum":30.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30.22,"methodology":"fee schedule"}]}]},{"description":"Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analys ","code_information":[{"code":"81412","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2448.56,"maximum":5141.98,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2693.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2619.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2595.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2595.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2791.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2693.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2619.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2693.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2619.96,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2938.27,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5141.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2815.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2460.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5141.98,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2570.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5141.98,"methodology":"fee schedule"}]}]},{"description":"Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each ","code_information":[{"code":"85032","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.91,"maximum":9.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9.05,"methodology":"fee schedule"}]}]},{"description":"Brentuximab vedotin inj ","code_information":[{"code":"9287","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":239.86,"maximum":503.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":263.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":256.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":254.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":254.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":273.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":263.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":256.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":263.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":256.65,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":244.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":287.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":503.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":275.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":241.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":503.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":251.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":239.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":503.70,"methodology":"fee schedule"}]}]},{"description":"Calcitonin ","code_information":[{"code":"82308","type":"CPT"},{"code":"L000090502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.28,"maximum":56.26,"gross_charge":20.90,"discounted_cash":20.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.40,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.15,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.79,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":56.26,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M < 31.15 ","code_information":[{"code":"158","type":"RC"},{"code":"B1404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35823.44,"maximum":41479.77,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39594.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39971.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35823.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37708.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41479.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37708.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39594.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35823.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36577.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37708.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37708.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37708.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36954.71,"methodology":"fee schedule"}]}]},{"description":"Oncology (non-small cell lung cancer), cell-free DNA, targeted sesquence analysis of 23 gene (single nucleotide variations, insertions and deletions, fusions without prior knowledge of partner/breakpo ","code_information":[{"code":"0179U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1943.21,"maximum":4080.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2137.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2079.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2059.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2059.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1982.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1982.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2215.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2137.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2079.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2137.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2079.23,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1982.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2331.85,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":4080.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2234.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1952.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":4080.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2040.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1943.21,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":4080.74,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M < 30.75 ","code_information":[{"code":"138","type":"RC"},{"code":"D1203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24781.58,"maximum":28694.46,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27390.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27651.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24781.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26085.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28694.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26085.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27390.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24781.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25303.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26085.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26085.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26085.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25564.16,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC ","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":56429.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11391.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11726.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11838.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11503.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":3711.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4992.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3711.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11280.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11280.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":5627.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":8721.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":5627.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":3711.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11838.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12285.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":56429.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23363.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":56429.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11503.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11391.79,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18933.60,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":19880.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11726.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11615.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11950.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10833.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11726.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11838.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21778.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13960.52,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11726.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11335.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11391.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10688.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11168.42,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21778.42,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11168.42,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11168.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11335.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10945.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21778.42,"methodology":"fee schedule"}]}]},{"description":"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC ","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":74007.23,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14751.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15185.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15330.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14896.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8671.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11666.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8671.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14607.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14607.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13149.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20379.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13149.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8671.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15330.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15908.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":74007.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":30640.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":74007.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14896.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14751.71,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24831.24,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":26072.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15185.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15040.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15474.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14028.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15185.58,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15330.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28201.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18078.07,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15185.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14679.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14751.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13840.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14462.46,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28201.80,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14462.46,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14462.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14679.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14173.21,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28201.80,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 24.15 & M < 34.35 ","code_information":[{"code":"138","type":"RC"},{"code":"B0903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29838.40,"maximum":34549.72,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32979.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33293.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29838.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31408.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34549.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31408.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32979.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29838.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30466.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31408.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31408.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31408.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30780.66,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 44.75 ","code_information":[{"code":"118","type":"RC"},{"code":"D0901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14976.80,"maximum":17341.55,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16553.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16710.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14976.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15765.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17341.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15765.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16553.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14976.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15292.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15765.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15765.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15765.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15449.75,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"138","type":"RC"},{"code":"D1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21235.63,"maximum":24588.62,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23470.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23694.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21235.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22353.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24588.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22353.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23470.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21235.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21682.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22353.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22353.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22353.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21906.23,"methodology":"fee schedule"}]}]},{"description":"PCA3/KLK3 (prostate cancer antigen 3 ºnon-protein coding»/kallikrein-related peptidase 3 ºprostate specific antigen») ratio (eg, prostate cancer) ","code_information":[{"code":"81313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":231.17,"maximum":535.61,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":272.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":270.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":260.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":260.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":290.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":272.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":280.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":272.90,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":260.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":231.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":306.06,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":535.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":293.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":256.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":535.61,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":267.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":255.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":535.61,"methodology":"fee schedule"}]}]},{"description":"Piflu f-18, dia 1 millicu ","code_information":[{"code":"9430","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":615.12,"maximum":1291.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":676.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":658.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":652.02,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":652.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":627.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":627.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":701.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":676.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":658.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":676.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":658.17,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":627.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":738.14,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1291.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":707.38,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":618.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1291.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":645.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":615.12,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1291.74,"methodology":"fee schedule"}]}]},{"description":"Prealbumin ","code_information":[{"code":"84134","type":"CPT"},{"code":"L000176301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.22,"maximum":30.64,"gross_charge":413.85,"discounted_cash":413.85,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.59,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30.64,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 29.15 & M < 39.05 ","code_information":[{"code":"118","type":"RC"},{"code":"B1503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30661.45,"maximum":35502.73,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33888.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34211.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30661.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35502.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33888.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30661.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31306.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32275.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31629.70,"methodology":"fee schedule"}]}]},{"description":"Quinine ","code_information":[{"code":"84228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.54,"maximum":24.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":24.42,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (colton blood group) genotyping (CO), gene analysis, AQP1 (aquaporin 1) exon 1 ","code_information":[{"code":"0181U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.20,"maximum":388.92,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":211.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":388.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":388.92,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":388.92,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"138","type":"RC"},{"code":"B0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28693.14,"maximum":33223.64,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31713.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32015.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28693.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33223.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31713.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28693.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29297.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29599.24,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"138","type":"RC"},{"code":"D0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14848.25,"maximum":17192.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16411.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16567.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14848.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17192.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16411.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14848.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15160.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15317.14,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"B1301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18205.55,"maximum":21080.11,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20121.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20313.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18205.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21080.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20121.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18205.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18588.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19163.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18780.46,"methodology":"fee schedule"}]}]},{"description":"Sedimentation rate, erythrocyte; non-automated ","code_information":[{"code":"85651","type":"CPT"},{"code":"L000212401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.87,"maximum":8.97,"gross_charge":1099.55,"discounted_cash":1099.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8.97,"methodology":"fee schedule"}]}]},{"description":"Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types ","code_information":[{"code":"87206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.89,"maximum":11.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11.32,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11.32,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"138","type":"RC"},{"code":"C0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36997.08,"maximum":42838.72,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40891.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41280.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36997.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42838.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40891.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36997.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37775.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38165.40,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 51.05 ","code_information":[{"code":"158","type":"RC"},{"code":"A0101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12344.04,"maximum":14293.10,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13643.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13773.36,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12344.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12993.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14293.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12993.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13643.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12344.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12603.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12993.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12993.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12993.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12733.86,"methodology":"fee schedule"}]}]},{"description":"Targeted genomic sequence analysis panel, cholangiocarcinoma and non-small cell lung neoplasia, DNA and RNA analysis, 1-23 genes, interrogation for sequence variants and rearrangements, reported as pr ","code_information":[{"code":"0022U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1767.42,"maximum":4095.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2145.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2086.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2067.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2067.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1989.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1989.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2223.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2145.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2086.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2145.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2086.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1989.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1767.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2340.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":4095.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2242.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1959.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":4095.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2047.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":4095.00,"methodology":"fee schedule"}]}]},{"description":"Thymol turbidity, blood ","code_information":[{"code":"P2033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.69,"maximum":10.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10.40,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"158","type":"RC"},{"code":"C0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36279.20,"maximum":42007.50,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40098.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40479.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36279.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42007.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40098.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36279.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37042.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37424.86,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & C < 23.5 ","code_information":[{"code":"118","type":"RC"},{"code":"C0203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22836.65,"maximum":26442.44,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25240.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25480.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22836.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24038.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26442.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24038.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25240.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22836.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23317.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24038.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24038.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24038.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23557.81,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A > 63.5 ","code_information":[{"code":"118","type":"RC"},{"code":"C0404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":45245.92,"maximum":52390.01,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":50008.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":50484.92,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":45245.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":52390.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":50008.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":45245.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":46198.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":46674.73,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"128","type":"RC"},{"code":"C0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23092.08,"maximum":26738.20,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25522.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25765.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23092.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26738.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25522.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23092.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23578.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23821.30,"methodology":"fee schedule"}]}]},{"description":"URETHRAL STRICTURE ","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":43890.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8994.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9259.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9347.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9083.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6358.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8555.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6358.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8906.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8906.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9642.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14944.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9642.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6358.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9347.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9700.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":43890.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":18171.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":43890.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9083.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8994.96,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14726.46,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":15462.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9259.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9171.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9435.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8554.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9259.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9347.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":17196.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11023.23,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9259.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8950.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8994.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8439.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8818.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":17196.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8818.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8818.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8950.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8642.21,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":17196.24,"methodology":"fee schedule"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH CC ","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":90462.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18489.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19033.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19214.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":29603.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18670.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":24121.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32453.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":24121.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18308.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18308.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36578.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":56689.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36578.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":24121.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19214.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19939.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":90462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37453.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":90462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18670.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18489.33,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31391.85,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":32961.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19033.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18851.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19395.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17582.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19033.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19214.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35347.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22658.49,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19033.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18398.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18489.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":38161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17347.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18126.79,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35347.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18126.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18126.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18398.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17764.25,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35347.24,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & M < 53.35 & C ","code_information":[{"code":"138","type":"RC"},{"code":"A0202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15681.31,"maximum":18157.31,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17331.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17497.04,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15681.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16506.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18157.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16506.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17331.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15681.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16011.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16506.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16506.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16506.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16176.51,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A > 63.5 ","code_information":[{"code":"128","type":"RC"},{"code":"D0404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43922.03,"maximum":50857.08,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":48545.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":49007.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":43922.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46233.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":50857.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":46233.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48545.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43922.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44846.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46233.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":46233.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":46233.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":45309.04,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"148","type":"RC"},{"code":"C0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23092.08,"maximum":26738.20,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25522.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25765.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23092.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26738.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25522.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23092.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23578.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23821.30,"methodology":"fee schedule"}]}]},{"description":"Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, w ","code_information":[{"code":"81001","type":"CPT"},{"code":"L000039801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2.87,"maximum":6.66,"gross_charge":784.70,"discounted_cash":784.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6.66,"methodology":"fee schedule"}]}]},{"description":"VENTRICULAR SHUNT PROCEDURES WITH MCC ","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":90462.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35697.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36747.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37097.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":29603.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":36047.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":24121.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32453.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":24121.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35347.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35347.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36578.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":56689.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36578.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":24121.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":37097.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38497.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":90462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37453.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":90462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36047.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35697.61,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":61597.41,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":64677.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36747.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":36397.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37447.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33947.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36747.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":37097.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":68245.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43747.08,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":36747.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35522.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35697.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":79985.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":33492.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34997.66,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":68245.44,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":34997.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":34997.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35522.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34297.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":68245.44,"methodology":"fee schedule"}]}]},{"description":"Y90 ibritumomab, rx ","code_information":[{"code":"1643","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":65476.58,"maximum":137500.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":72024.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":70059.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":69405.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":69405.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":66786.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":66786.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":74643.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":72024.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":70059.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":72024.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":70059.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":66786.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":78571.90,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":137500.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":75298.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":65803.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":137500.82,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":68750.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":65476.58,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":137500.82,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"138","type":"RC"},{"code":"D0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14708.01,"maximum":17030.33,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16256.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16411.04,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14708.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17030.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16256.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14708.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15017.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15482.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15172.47,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 29.25 & M < 3 ","code_information":[{"code":"148","type":"RC"},{"code":"D0504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26634.69,"maximum":30840.17,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29438.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29718.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26634.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28036.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30840.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28036.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29438.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26634.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27195.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28036.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28036.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28036.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27475.78,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"148","type":"RC"},{"code":"B0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21200.57,"maximum":24548.03,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23432.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23655.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21200.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22316.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24548.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22316.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23432.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21200.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21646.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22316.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22316.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22316.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21870.06,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), mRNA, next-generation sequencing gene expression profiling of 70 content genes and 31 housekeeping genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as in ","code_information":[{"code":"81523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3873.00,"maximum":8133.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4415.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8133.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4453.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8133.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8133.30,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate), mRNA expression profiling of HOXC6 and DLX1, reverse transcription polymerase chain reaction (RT-PCR), first void urine following digital rectal examination, algorithn reporteed a ","code_information":[{"code":"0339U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760.00,"maximum":1596.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":866.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1596.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1596.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1596.00,"methodology":"fee schedule"}]}]},{"description":"Osmotic fragility, RBC; unincubated ","code_information":[{"code":"85555","type":"CPT"},{"code":"L000209202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.77,"maximum":15.69,"gross_charge":527.30,"discounted_cash":527.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":15.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":15.69,"methodology":"fee schedule"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC ","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":103123.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26617.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":103123.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":84040.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27400.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27661.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":126682.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":59203.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":116319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":26878.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":51182.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":68860.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":51182.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26356.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26356.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":77612.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":120286.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":77612.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":51182.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27661.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28705.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26878.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26617.79,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":45659.67,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":47942.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27400.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27139.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27922.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25312.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27400.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":27661.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":50886.95,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32619.84,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":27400.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26487.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26617.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":86811.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24973.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26095.87,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":50886.95,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26095.87,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26095.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26487.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25573.95,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":50886.95,"methodology":"fee schedule"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":69792.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13713.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14116.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14251.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13847.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":29696.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":39953.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":29696.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13578.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13578.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":45032.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":69792.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":45032.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":29696.94,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14251.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14788.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":68574.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28391.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":68574.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13847.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13713.25,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23008.44,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":24158.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14116.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13982.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14385.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13041.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14116.58,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14251.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26216.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16805.45,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14116.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13646.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13713.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12866.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13444.36,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26216.50,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13444.36,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13444.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13646.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13175.47,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26216.50,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M < 24.15 ","code_information":[{"code":"158","type":"RC"},{"code":"C0904","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28636.38,"maximum":33157.91,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31650.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31952.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28636.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30143.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33157.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30143.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31650.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28636.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29239.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30143.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30143.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30143.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29540.69,"methodology":"fee schedule"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC ","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":80048.91,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15906.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16374.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16530.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16062.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":27477.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36967.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":27477.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15750.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15750.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":41666.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":64575.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":41666.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":27477.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16530.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17154.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":80048.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":33141.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":80048.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16062.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15906.57,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":26858.37,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":28201.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16374.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16218.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16686.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15126.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16374.41,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16530.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30409.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19493.35,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16374.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15828.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15906.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14924.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15594.68,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30409.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15594.68,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15594.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15828.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15282.79,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30409.63,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 37.15 ","code_information":[{"code":"128","type":"RC"},{"code":"A1601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":13584.46,"maximum":15729.37,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15014.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15157.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13584.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14299.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15729.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14299.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15014.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13584.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13870.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14299.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14299.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14299.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14013.44,"methodology":"fee schedule"}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH CC ","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":92548.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18295.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18833.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19013.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18475.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25082.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":33745.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25082.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18116.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18116.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":38034.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58946.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":38034.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25082.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19013.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19730.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":92548.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":38316.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":92548.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18475.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18295.87,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31052.28,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":32604.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18833.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18654.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19192.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17399.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18833.99,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19013.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":34977.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22421.41,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18833.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18206.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18295.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17165.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17937.13,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":34977.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17937.13,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17937.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18206.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17578.39,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":34977.40,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC ","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":80552.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16002.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16473.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16630.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16159.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10730.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14436.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10730.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15845.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15845.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16271.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":25218.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16271.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10730.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16630.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17258.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":80552.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":33350.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":80552.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16159.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16002.88,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27027.42,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":28378.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16473.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16316.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16787.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15218.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16473.56,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16630.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30593.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19611.38,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16473.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15924.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16002.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15014.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15689.10,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30593.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15689.10,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15689.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15924.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15375.32,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30593.74,"methodology":"fee schedule"}]}]},{"description":"Protoporphyrin, RBC; quantitative ","code_information":[{"code":"84202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.01,"maximum":30.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":30.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":30.14,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 39.05 & M < 49.25 ","code_information":[{"code":"118","type":"RC"},{"code":"A1502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19263.99,"maximum":22305.67,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21291.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21494.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19263.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20277.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22305.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20277.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21291.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19263.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19669.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20277.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20277.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20277.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19872.33,"methodology":"fee schedule"}]}]},{"description":"RECTAL RESECTION WITH MCC ","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":151961.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29652.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30524.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30815.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":29943.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":32925.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":44296.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":32925.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29362.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29362.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":49927.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":77378.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49927.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":32925.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30815.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31978.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":151961.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":62915.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":151961.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29943.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29652.77,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":50986.95,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":53536.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30524.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":30234.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31106.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28199.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30524.91,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":30815.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":56689.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36339.18,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":30524.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29507.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29652.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27821.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29071.34,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":56689.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":29071.34,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":29071.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29507.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28489.91,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":56689.11,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"138","type":"RC"},{"code":"D0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20991.89,"maximum":24306.40,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23201.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23422.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20991.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24306.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23201.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20991.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21433.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22096.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21654.79,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"118","type":"RC"},{"code":"D0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14848.25,"maximum":17192.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16411.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16567.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14848.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17192.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16411.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14848.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15160.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15317.14,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"128","type":"RC"},{"code":"D1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28217.34,"maximum":32672.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31187.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31484.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28217.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32672.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31187.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28217.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28811.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29702.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29108.42,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISOR ","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":164032.13,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31959.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32899.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33213.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":32273.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25456.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":34249.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25456.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31646.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31646.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":38602.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":59827.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":38602.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25456.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33213.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34466.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":164032.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":67912.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":164032.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32273.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31959.99,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":55036.80,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":57788.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32899.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":32586.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33526.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30393.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32899.99,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":33213.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":61099.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39166.65,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":32899.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31803.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31959.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29985.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31333.32,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":61099.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":31333.32,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":31333.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31803.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30706.65,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":61099.97,"methodology":"fee schedule"}]}]},{"description":"Stereoscopic x-ray guidan ","code_information":[{"code":"4002","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":50.78,"maximum":106.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":53.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":57.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":51.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":106.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":106.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":106.64,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"118","type":"RC"},{"code":"D0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27037.03,"maximum":31306.04,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29883.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30167.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27037.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31306.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29883.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27037.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27606.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27890.83,"methodology":"fee schedule"}]}]},{"description":"Sulfate, urine ","code_information":[{"code":"84392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.98,"maximum":11.53,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"Thiocyanate ","code_information":[{"code":"84430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.54,"maximum":24.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":24.42,"methodology":"fee schedule"}]}]},{"description":"Transplantation medicine (allograft rejection, renal), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection ","code_information":[{"code":"0018M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":640.73,"maximum":1345.53,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":704.80,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":685.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":679.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":679.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":730.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":704.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":685.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":704.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":685.58,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":768.88,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1345.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":736.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":643.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1345.53,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":672.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1345.53,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & M < 53.35 & C ","code_information":[{"code":"138","type":"RC"},{"code":"B0202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22264.02,"maximum":25779.39,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24607.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24841.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22264.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23435.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25779.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23435.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24607.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22264.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22732.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23435.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23435.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23435.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22967.10,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A > 63.5 ","code_information":[{"code":"128","type":"RC"},{"code":"C0404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":45245.92,"maximum":52390.01,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":50008.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":50484.92,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":45245.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":52390.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":50008.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":45245.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":46198.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":47627.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":46674.73,"methodology":"fee schedule"}]}]},{"description":"Troponin, qualitative ","code_information":[{"code":"84512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.15,"maximum":21.19,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.80,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21.19,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21.19,"methodology":"fee schedule"}]}]},{"description":"Volatiles (eg, acetic anhydride, diethylether) ","code_information":[{"code":"84600","type":"CPT"},{"code":"L000195602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.51,"maximum":35.93,"gross_charge":23.35,"discounted_cash":23.35,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35.93,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35.93,"methodology":"fee schedule"}]}]},{"description":"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY ","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47137.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9615.52,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9898.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9992.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9709.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4016.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":5403.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4016.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9521.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9521.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6090.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":9438.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6090.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4016.20,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9992.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10369.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47137.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19515.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47137.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9709.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9615.52,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15815.73,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":16606.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9898.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9804.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10086.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9144.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9898.33,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9992.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18382.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11783.72,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9898.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9568.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9615.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9021.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9426.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18382.61,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9426.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9426.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9568.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9238.44,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18382.61,"methodology":"fee schedule"}]}]},{"description":"Adrenocorticotropic hormone (ACTH) ","code_information":[{"code":"82024","type":"CPT"},{"code":"L000082502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":35.01,"maximum":81.10,"gross_charge":18.75,"discounted_cash":18.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":44.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":81.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":38.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":81.10,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":81.10,"methodology":"fee schedule"}]}]},{"description":"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES ","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":1652159.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":316415.93,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":325722.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":328824.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":319518.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":313313.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":313313.82,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":328824.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":341232.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":1652159.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":684025.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1652159.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":319518.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 13+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":316415.93,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":554339.94,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":582056.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":325722.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":322620.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":331926.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":300905.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":325722.29,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":328824.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":604912.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":387764.63,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":325722.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":314864.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316415.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":310211.70,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":604912.82,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":310211.70,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":310211.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":314864.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":604912.82,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor VII (proconvertin, stable factor) ","code_information":[{"code":"85230","type":"CPT"},{"code":"L000201402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.23,"maximum":37.59,"gross_charge":147.25,"discounted_cash":147.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":37.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":37.59,"methodology":"fee schedule"}]}]},{"description":"Creatinine; blood ","code_information":[{"code":"82565","type":"CPT"},{"code":"L000104901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.64,"maximum":10.75,"gross_charge":250.55,"discounted_cash":250.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10.75,"methodology":"fee schedule"}]}]},{"description":"CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, 3? gene duplication/multiplication) (List separately in addition to ","code_information":[{"code":"0076U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.91,"maximum":946.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":514.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":541.09,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":518.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":453.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":473.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC ","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":42331.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8696.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8952.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9037.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8782.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11475.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15439.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11475.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8611.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8611.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17401.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26969.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17401.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11475.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9037.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9378.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":42331.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":17525.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":42331.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8782.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8696.82,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14203.14,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":14913.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8952.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8867.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9123.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8270.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8952.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9037.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":16626.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10657.86,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8952.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8654.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8696.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8159.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8526.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":16626.27,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8526.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8526.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8654.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8355.77,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":16626.27,"methodology":"fee schedule"}]}]},{"description":"Endomysial antibody (EMA), each immunoglobulin (Ig) class ","code_information":[{"code":"86231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.96,"maximum":25.39,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.39,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, ORTHOPEDIC, LENGTH OF STAY IS 13 DAYS OR ","code_information":[{"code":"118","type":"RC"},{"code":"A5101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12557.74,"maximum":14540.54,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13879.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14011.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12557.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14540.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13879.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12557.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12822.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13218.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12954.30,"methodology":"fee schedule"}]}]},{"description":"FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability ºXLID») gene analysis; characterization of alleles (eg, expanded size and promoter methylation ","code_information":[{"code":"81244","type":"CPT"},{"code":"L000052001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":44.89,"maximum":94.27,"gross_charge":192.65,"discounted_cash":192.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47.58,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":47.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":51.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":94.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":45.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":94.27,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":94.27,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"158","type":"RC"},{"code":"A0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14177.12,"maximum":16415.61,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15669.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15818.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14177.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14923.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16415.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14923.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15669.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14177.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14475.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14923.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14923.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14923.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14624.82,"methodology":"fee schedule"}]}]},{"description":"Galactose-1-phosphate uridyl transferase; quantitative ","code_information":[{"code":"82775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19.10,"maximum":44.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":19.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":44.25,"methodology":"fee schedule"}]}]},{"description":"Genome (eg, unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis ","code_information":[{"code":"0094U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7582.20,"maximum":15922.62,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8340.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8112.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8037.13,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8037.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7733.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7733.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8643.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8340.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8112.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8340.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8112.95,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7733.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9098.64,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":15922.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8719.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7620.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":15922.62,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7961.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7582.20,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":15922.62,"methodology":"fee schedule"}]}]},{"description":"Haloperidol ","code_information":[{"code":"80173","type":"CPT"},{"code":"L000003802","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.30,"maximum":33.14,"gross_charge":1007.90,"discounted_cash":1007.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":33.14,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin (Hgb), quantitative, transcutaneous ","code_information":[{"code":"88738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.55,"maximum":10.54,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10.54,"methodology":"fee schedule"}]}]},{"description":"Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney ","code_information":[{"code":"86310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.68,"maximum":15.48,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"Hyperbaric Oxygen ","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":127.74,"maximum":268.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":136.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":135.40,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":135.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":130.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":130.29,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":145.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":136.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":140.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":136.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":130.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":153.28,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":268.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":146.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":128.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":268.25,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":134.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":127.74,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":268.25,"methodology":"fee schedule"}]}]},{"description":"Immunofixation electrophoresis; serum ","code_information":[{"code":"86334","type":"CPT"},{"code":"L000263902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":20.24,"maximum":46.91,"gross_charge":183.70,"discounted_cash":183.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":46.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":46.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":46.91,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; cryptosporidium ","code_information":[{"code":"87272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":25.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.16,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed ","code_information":[{"code":"87522","type":"CPT"},{"code":"L000367902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":38.83,"maximum":89.96,"gross_charge":351.90,"discounted_cash":351.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":48.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":89.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":49.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":89.96,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":89.96,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, direct probe technique ","code_information":[{"code":"87560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.73,"maximum":57.31,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.20,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.75,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":57.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":57.31,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.29,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":57.31,"methodology":"fee schedule"}]}]},{"description":"Infectious disease (bacterial or viral RTI) pathogen-specific DNA & RN A,21 targets,incl severe acute respiratory syndrome coronavirus 2(SARS- CoV-2), amplified probe technique,including multiple ","code_information":[{"code":"0225U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":377.76,"maximum":875.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":441.79,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":441.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":475.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":377.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":500.14,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":875.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":479.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":418.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":875.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":437.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":875.24,"methodology":"fee schedule"}]}]},{"description":"Inj crizanlizumab-tmca 5m ","code_information":[{"code":"9359","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":128.54,"maximum":269.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":141.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":137.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":136.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":131.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":131.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":146.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":141.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":137.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":141.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":137.54,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":131.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":154.25,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":269.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":147.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":129.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":269.93,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":134.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":128.54,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":269.93,"methodology":"fee schedule"}]}]},{"description":"Inj xipere 1 mg ","code_information":[{"code":"9358","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":48.40,"maximum":101.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":51.30,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":51.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":55.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":51.79,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":49.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":58.08,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":101.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":55.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":48.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":101.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":50.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48.40,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":101.64,"methodology":"fee schedule"}]}]},{"description":"Inj, kovaltry, 1 i.u. ","code_information":[{"code":"9075","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.48,"maximum":3.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3.10,"methodology":"fee schedule"}]}]},{"description":"Inj. naxitamab-gqgk, 1 mg ","code_information":[{"code":"9408","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":642.15,"maximum":1348.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":706.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":687.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":680.67,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":680.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":654.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":654.99,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":732.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":706.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":687.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":706.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":687.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":654.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":770.58,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1348.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":738.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":645.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1348.51,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":674.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1348.51,"methodology":"fee schedule"}]}]},{"description":"Intensive Outpatient (4 o ","code_information":[{"code":"5852","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":152.09,"maximum":319.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":167.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":162.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":161.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":161.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":155.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":155.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":173.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":167.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":162.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":167.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":162.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":155.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":182.51,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":319.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":174.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":152.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":319.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":159.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":152.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":319.40,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC ","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":141232.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27601.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28413.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28684.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":27872.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":27474.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36963.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":27474.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27331.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27331.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":41661.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":64568.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":41661.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":27474.16,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28684.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29766.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":141232.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":58472.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":141232.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27872.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27601.81,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":47386.92,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":49756.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28413.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":28143.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28954.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26248.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28413.63,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":28684.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":52768.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33825.75,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":28413.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27466.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27601.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":57365.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25896.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27060.60,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":52768.17,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":27060.60,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":27060.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27466.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26519.39,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":52768.17,"methodology":"fee schedule"}]}]},{"description":"Level 1 Electronic Analys ","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":34.71,"maximum":72.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":36.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":39.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.14,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":72.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":39.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":72.90,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":72.90,"methodology":"fee schedule"}]}]},{"description":"Level 2 Pathology ","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":157.23,"maximum":330.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":172.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":168.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":166.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":179.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":172.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":168.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":172.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":168.24,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":160.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":188.68,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":330.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":180.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":158.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":330.19,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":165.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":157.23,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":330.19,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) ","code_information":[{"code":"83718","type":"CPT"},{"code":"L000166601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.42,"maximum":17.20,"gross_charge":1391.40,"discounted_cash":1391.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":17.20,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"158","type":"RC"},{"code":"A1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18113.73,"maximum":20973.79,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20020.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20211.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18113.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19067.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20973.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19067.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20020.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18113.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18495.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19067.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19067.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19067.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18685.74,"methodology":"fee schedule"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITH MCC ","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":73161.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14590.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15019.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15162.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14733.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11912.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16027.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11912.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14447.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14447.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18064.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27996.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18064.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11912.61,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15162.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15734.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":73161.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":30290.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":73161.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14733.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14590.08,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24547.53,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":25774.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15019.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14876.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15305.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13874.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15019.20,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15162.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27892.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17880.00,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15019.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14518.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14590.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13688.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14304.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27892.80,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14304.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14304.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14518.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14017.92,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27892.80,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"148","type":"RC"},{"code":"A1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23429.31,"maximum":27128.68,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25895.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26142.18,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23429.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24662.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27128.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24662.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25895.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23429.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23922.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24662.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24662.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24662.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24169.18,"methodology":"fee schedule"}]}]},{"description":"Manganese ","code_information":[{"code":"83785","type":"CPT"},{"code":"L000167502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.15,"maximum":55.96,"gross_charge":58.45,"discounted_cash":58.45,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":55.96,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":55.96,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M < 27.85 ","code_information":[{"code":"158","type":"RC"},{"code":"B2004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35180.69,"maximum":40735.54,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":38883.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39254.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35180.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40735.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38883.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35180.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35921.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37032.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36291.66,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 49.15 ","code_information":[{"code":"158","type":"RC"},{"code":"C2001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15741.41,"maximum":18226.90,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17398.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17564.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15741.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18226.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17398.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15741.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16072.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16238.51,"methodology":"fee schedule"}]}]},{"description":"Nephelometry, each analyte not elsewhere specified ","code_information":[{"code":"83883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.33,"maximum":28.56,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.56,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"148","type":"RC"},{"code":"D0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15504.35,"maximum":17952.40,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17136.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17299.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15504.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17952.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17136.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15504.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15830.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15993.96,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 3 ","code_information":[{"code":"1540","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":145.41,"maximum":305.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":155.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":154.13,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":154.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":148.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":148.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":165.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":155.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":155.59,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":148.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":174.49,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":305.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":167.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":146.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":305.35,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":152.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":145.41,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":305.35,"methodology":"fee schedule"}]}]},{"description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes ","code_information":[{"code":"98971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.63,"maximum":43.32,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.63,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":43.32,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 35.05 & M < 41.05 ","code_information":[{"code":"128","type":"RC"},{"code":"D0302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19015.24,"maximum":22017.64,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21016.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21217.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19015.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20016.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22017.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20016.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21016.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19015.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19415.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20016.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20016.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20016.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19615.72,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"158","type":"RC"},{"code":"A0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14357.42,"maximum":16624.38,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15868.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16019.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14357.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15113.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16624.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15113.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15868.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14357.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14659.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15113.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15113.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15113.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14810.82,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), augmentative algorithmic analysis of digitized whole slide imaging of 8 histologic and immunohistochemical features, reported as a recurrence score ","code_information":[{"code":"0418U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":706.25,"maximum":1483.13,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":748.63,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":748.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":805.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":847.50,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1483.13,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":812.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":709.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1483.13,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":741.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1483.13,"methodology":"fee schedule"}]}]},{"description":"Aldolase ","code_information":[{"code":"82085","type":"CPT"},{"code":"L000083402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.80,"maximum":20.39,"gross_charge":3.50,"discounted_cash":3.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20.39,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH ","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":84653.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16786.75,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17280.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17445.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16951.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":35032.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":47131.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":35032.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16622.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16622.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":53122.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":82330.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":53122.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":35032.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17445.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18103.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":84653.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":35048.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":84653.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16951.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16786.75,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28403.34,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":29823.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17280.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17115.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17609.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15963.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17280.48,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17445.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":32092.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20572.00,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17280.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16704.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16786.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15749.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16457.60,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":32092.32,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16457.60,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16457.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16704.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16128.45,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":32092.32,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"158","type":"RC"},{"code":"A1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21147.15,"maximum":24486.17,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23373.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23595.77,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21147.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22260.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24486.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22260.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23373.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21147.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21592.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22260.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22260.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22260.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21814.95,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M=12-37 ","code_information":[{"code":"118","type":"RC"},{"code":"B1103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33482.85,"maximum":38769.61,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37007.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37359.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33482.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35245.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38769.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35245.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37007.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33482.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34187.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35245.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35245.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35245.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34540.20,"methodology":"fee schedule"}]}]},{"description":"Antibody; Borrelia burgdorferi (Lyme disease) ","code_information":[{"code":"86618","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.43,"maximum":35.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.44,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35.76,"methodology":"fee schedule"}]}]},{"description":"Antibody; varicella-zoster ","code_information":[{"code":"86787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.68,"maximum":27.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.05,"methodology":"fee schedule"}]}]},{"description":"Aripirazole lauroxil 1 mg ","code_information":[{"code":"9470","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3.23,"maximum":6.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6.78,"methodology":"fee schedule"}]}]},{"description":"Baclofen 10 MG injection ","code_information":[{"code":"9032","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":174.58,"maximum":366.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":186.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.06,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":185.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":199.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":186.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":186.80,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":178.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":209.50,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":366.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":200.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":175.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":366.62,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":183.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":174.58,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":366.62,"methodology":"fee schedule"}]}]},{"description":"Blood count; manual differential WBC count, buffy coat ","code_information":[{"code":"85009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.60,"maximum":10.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10.65,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10.65,"methodology":"fee schedule"}]}]},{"description":"BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) ","code_information":[{"code":"81167","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":282.88,"maximum":594.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":322.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.46,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":594.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":594.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":594.05,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"158","type":"RC"},{"code":"B2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":38691.59,"maximum":44800.78,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":42764.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43171.66,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":38691.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44800.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":42764.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":38691.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":39506.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39913.42,"methodology":"fee schedule"}]}]},{"description":"Calculus; X-ray diffraction ","code_information":[{"code":"82370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.35,"maximum":26.29,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26.29,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M < 31.15 ","code_information":[{"code":"138","type":"RC"},{"code":"A1404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24143.84,"maximum":27956.03,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26685.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26939.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24143.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27956.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26685.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24143.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24652.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24906.28,"methodology":"fee schedule"}]}]},{"description":"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; ","code_information":[{"code":"89050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.28,"maximum":9.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9.91,"methodology":"fee schedule"}]}]},{"description":"Chloroprocaine hcl inject ","code_information":[{"code":"9218","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.03,"maximum":0.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":0.06,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":0.06,"methodology":"fee schedule"}]}]},{"description":"Coagulation time; Lee and White ","code_information":[{"code":"85345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.25,"maximum":9.85,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9.85,"methodology":"fee schedule"}]}]},{"description":"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA ","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":299143.95,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":57786.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":59486.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":60052.79,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":58353.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":74919.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":100794.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":74919.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":57220.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":57220.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":113606.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":176070.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":113606.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":74919.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":60052.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":62318.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":299143.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":123851.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":299143.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":58353.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":57786.65,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":100370.13,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":105388.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":59486.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":58919.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":60619.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":54953.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":59486.26,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":60052.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":110474.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":70816.98,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":59486.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":57503.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":57786.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":78215.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":54217.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":56653.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":110474.48,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":56653.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":56653.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":57503.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":55520.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":110474.48,"methodology":"fee schedule"}]}]},{"description":"Culture, presumptive, pathogenic organisms, screening only; ","code_information":[{"code":"87081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.01,"maximum":13.92,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.09,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13.92,"methodology":"fee schedule"}]}]},{"description":"DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC ","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":34602.72,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7219.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7431.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7502.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7290.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9053.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12180.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9053.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7148.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7148.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13729.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21277.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13729.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9053.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7502.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7785.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":34602.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14326.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":34602.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7290.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7219.53,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11610.06,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":12190.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7431.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7361.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7573.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6865.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7431.86,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7502.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13802.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8847.46,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7431.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7184.14,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7219.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6773.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7077.97,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13802.03,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7077.97,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7077.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7184.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6936.41,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13802.03,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care ","code_information":[{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11.15,"maximum":24.13,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":24.13,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":24.13,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, ORTHOPEDIC, LENGTH OF STAY IS 14 DAYS OR ","code_information":[{"code":"148","type":"RC"},{"code":"A5102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29926.88,"maximum":34652.18,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33077.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33392.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29926.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31501.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34652.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31501.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33077.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29926.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30556.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31501.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31501.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31501.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30871.94,"methodology":"fee schedule"}]}]},{"description":"FGFR3 (fibroblast growth factor receptor 3) gene analysis ","code_information":[{"code":"0154U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.99,"maximum":1012.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":530.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":515.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":511.07,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":511.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":491.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":491.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":549.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":530.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":515.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":530.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":515.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":491.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":436.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":578.57,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1012.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":554.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":484.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1012.49,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":506.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":482.14,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1012.49,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M < 28.15 ","code_information":[{"code":"128","type":"RC"},{"code":"A0704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26304.13,"maximum":30457.42,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29072.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29349.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26304.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27688.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30457.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27688.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29072.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26304.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26857.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27688.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27688.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27688.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27134.79,"methodology":"fee schedule"}]}]},{"description":"FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY ","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":94007.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18574.75,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19121.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19303.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18756.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15180.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20423.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15180.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18392.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18392.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":23019.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35676.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23019.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15180.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19303.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20031.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":94007.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":38920.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":94007.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18756.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18574.75,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31541.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19121.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18938.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19485.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17664.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19121.07,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19303.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35510.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22763.18,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19121.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18483.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18574.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17427.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18210.54,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35510.55,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18210.54,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18210.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18483.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17846.33,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35510.55,"methodology":"fee schedule"}]}]},{"description":"Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2) ","code_information":[{"code":"80424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45.77,"maximum":106.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":57.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":106.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":50.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":106.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":106.05,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 18.05 & M < 35.95 ","code_information":[{"code":"118","type":"RC"},{"code":"A1902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19589.53,"maximum":22682.62,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21651.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21857.80,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19589.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20620.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22682.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20620.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21651.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19589.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20001.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20620.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20620.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20620.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20208.15,"methodology":"fee schedule"}]}]},{"description":"Hematology (genetic platelet disorders), genomic sequence analysis of 43 genes, blood, buccal swab, or amniotic fluid ","code_information":[{"code":"0274U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":608.17,"maximum":1277.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":693.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":729.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1277.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":699.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":611.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1277.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":638.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1277.16,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use ","code_information":[{"code":"83037","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.80,"maximum":20.39,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20.39,"methodology":"fee schedule"}]}]},{"description":"Hereditary prostate cancer-related disorders, targeted mRNA sequence analysis panel (11 genes) (List separately in addition to code for primary procedure) ","code_information":[{"code":"0133U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":690.29,"maximum":1449.61,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":759.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":738.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":731.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":731.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":704.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":704.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":786.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":759.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":738.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":759.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":738.61,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":704.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":828.35,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1449.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":793.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":693.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1449.61,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":724.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":690.29,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1449.61,"methodology":"fee schedule"}]}]},{"description":"IDH1 (isocitrate dehydrogenase 1 ºNADP+», soluble) (eg, glioma), common variants (eg, R132H, R132C) ","code_information":[{"code":"81120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":193.25,"maximum":405.83,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":204.84,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":204.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":220.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":231.90,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":405.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":194.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":405.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":202.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":405.83,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening ","code_information":[{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17.74,"maximum":41.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":41.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":41.10,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":41.10,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":25.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.16,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody (DFA) ","code_information":[{"code":"87271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.16,"maximum":28.18,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.18,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique ","code_information":[{"code":"87520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28.29,"maximum":65.56,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":33.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.41,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":28.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.46,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":65.56,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.22,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":65.56,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique ","code_information":[{"code":"87661","type":"CPT"},{"code":"L000373301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":73.69,"gross_charge":150.60,"discounted_cash":150.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":40.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":73.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":73.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":73.69,"methodology":"fee schedule"}]}]},{"description":"Inhibin A ","code_information":[{"code":"86336","type":"CPT"},{"code":"L000264502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.13,"maximum":32.74,"gross_charge":66.90,"discounted_cash":66.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":32.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":32.74,"methodology":"fee schedule"}]}]},{"description":"Inj IVIG privigen 500 mg ","code_information":[{"code":"1214","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":48.58,"maximum":102.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":51.49,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":51.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":55.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":53.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":49.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":58.29,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":102.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":55.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":102.02,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":51.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":102.02,"methodology":"fee schedule"}]}]},{"description":"Inj ronzanolixizum-noli 1 ","code_information":[{"code":"721","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":22.80,"maximum":47.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":24.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":47.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":47.87,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":47.87,"methodology":"fee schedule"}]}]},{"description":"Inj, brixadi, 7 days or l ","code_information":[{"code":"732","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":429.16,"maximum":901.23,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":472.07,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":459.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":454.91,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":454.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":437.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":437.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":489.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":472.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":459.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":472.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":459.20,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":437.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":514.99,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":901.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":493.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":431.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":901.23,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":450.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":429.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":901.23,"methodology":"fee schedule"}]}]},{"description":"Inj, vasopressin, 1 unit ","code_information":[{"code":"1233","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.62,"maximum":3.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3.40,"methodology":"fee schedule"}]}]},{"description":"Inj., guselkumab, 1 mg ","code_information":[{"code":"9029","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":74.47,"maximum":156.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":79.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":78.94,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":78.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":75.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":75.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":84.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":79.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":81.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":79.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":75.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":89.36,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":156.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":85.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":74.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":156.39,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":78.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":74.47,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":156.39,"methodology":"fee schedule"}]}]},{"description":"Insulin; free ","code_information":[{"code":"83527","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.74,"maximum":27.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.20,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC ","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":92912.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18365.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18905.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19085.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18545.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":27474.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36963.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":27474.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18185.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18185.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":41661.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":64568.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":41661.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":27474.16,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19085.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19805.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":92912.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":38467.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":92912.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18545.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18365.39,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31174.29,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":32733.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18905.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18725.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19265.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17465.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18905.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19085.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35110.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22506.60,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18905.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18275.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18365.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":39034.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17231.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18005.28,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35110.30,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18005.28,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18005.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18275.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17645.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35110.30,"methodology":"fee schedule"}]}]},{"description":"Level 3 Breast/Lymphatic ","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":8677.68,"maximum":18223.13,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9545.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9285.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9198.34,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9198.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8851.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8851.24,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9892.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9545.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9285.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9545.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9285.12,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8851.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10413.22,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":18223.13,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9979.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8721.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":18223.13,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9111.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8677.68,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":18223.13,"methodology":"fee schedule"}]}]},{"description":"Lymphocytotoxicity assay, visual crossmatch; with titration ","code_information":[{"code":"86805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171.77,"maximum":397.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":208.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":202.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":200.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":193.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":193.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":216.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":208.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":202.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":208.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":202.78,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":193.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":171.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":227.41,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":397.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":217.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":190.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":397.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":198.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":189.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":397.97,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"138","type":"RC"},{"code":"D1703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23724.81,"maximum":27470.83,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26222.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26471.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23724.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27470.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26222.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23724.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24224.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24474.01,"methodology":"fee schedule"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH MCC ","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":244216.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":47287.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":48678.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":49141.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":47750.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":35822.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":48194.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":35822.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":46823.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":46823.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":54320.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":84187.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":54320.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":35822.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":49141.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":50996.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":244216.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":101110.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":244216.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47750.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 11+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":47287.32,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":81940.74,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":86037.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48678.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":48214.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49605.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44969.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":48678.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":49141.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":90402.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":57950.15,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":48678.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":47055.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":47287.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":44366.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":46360.12,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":90402.23,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":46360.12,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":46360.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":47055.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":45432.92,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":90402.23,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"138","type":"RC"},{"code":"C1801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14120.36,"maximum":16349.89,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15606.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15755.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14120.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14863.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16349.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14863.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15606.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14120.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14417.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14863.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14863.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14863.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14566.26,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; duplication/deletion variants ","code_information":[{"code":"81304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150.00,"maximum":315.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":159.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":159.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":171.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":180.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":315.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":172.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":150.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":315.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":157.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":315.00,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"158","type":"RC"},{"code":"A2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16688.00,"maximum":19322.95,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18444.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18620.29,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16688.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17566.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19322.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17566.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18444.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16688.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17039.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17566.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17566.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17566.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17214.99,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 8 (eg, analysis of 26-50 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of >50 exons, sequence analysis of multiple genes on on ","code_information":[{"code":"81407","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":846.27,"maximum":1777.17,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":930.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":905.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":897.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":897.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":964.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":930.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":905.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":930.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":905.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1015.52,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1777.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":973.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":850.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1777.17,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":888.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1777.17,"methodology":"fee schedule"}]}]},{"description":"Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (ECLIA) of tumor necrosis factor receptor 1A, receptor superfamily 2 (TNFR1, TNFR2), and kidney injury molecule-1 (KI ","code_information":[{"code":"0105U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":950.00,"maximum":1995.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1007.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1007.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1083.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1995.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1092.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":954.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1995.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1995.00,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 25.85 & M < 37.35 ","code_information":[{"code":"138","type":"RC"},{"code":"D0603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23170.54,"maximum":26829.05,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25609.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25853.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23170.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26829.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25609.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23170.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23658.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24390.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23902.24,"methodology":"fee schedule"}]}]},{"description":"Neurology, cerebrospinal fluid, detection of misfolded a-synuclein protein by see amplification assay, qualitative ","code_information":[{"code":"0393U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":490.33,"maximum":1136.08,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":595.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":578.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":573.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":573.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":551.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":551.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":616.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":595.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":578.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":595.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":578.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":551.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":490.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":649.19,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1136.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":622.14,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":543.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1136.08,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":568.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1136.08,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 30 ","code_information":[{"code":"1567","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":6038.98,"maximum":12681.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6642.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6461.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6401.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6401.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6159.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6159.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6884.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6642.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6461.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6642.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6461.71,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6159.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7246.78,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":12681.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6944.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6069.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":12681.86,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6340.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6038.98,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":12681.86,"methodology":"fee schedule"}]}]},{"description":"Nickel ","code_information":[{"code":"83885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.21,"maximum":51.47,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":51.47,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":51.47,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 35.05 & M < 41.05 ","code_information":[{"code":"128","type":"RC"},{"code":"B0302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25873.41,"maximum":29958.69,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28596.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28869.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25873.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27235.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29958.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27235.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28596.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25873.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26418.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27235.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27235.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27235.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26690.47,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 29.25 & M < 3 ","code_information":[{"code":"128","type":"RC"},{"code":"C0504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28192.30,"maximum":32643.72,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31159.91,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31456.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28192.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29676.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32643.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29676.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31159.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28192.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28785.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29676.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29676.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29676.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29082.59,"methodology":"fee schedule"}]}]},{"description":"Obstetrics (preterm birth), insulin-like growth factor-binding protein 4 (IBP4), sex hormone-binding globulin (SHBG), quantitative measurement by LC-MS/MS, utilizing maternal serum, combined with clin ","code_information":[{"code":"0247U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":750.00,"maximum":1575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":825.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":802.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":765.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":765.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":855.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":825.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":802.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":825.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":802.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":765.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1575.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":862.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":753.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1575.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":787.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1575.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (minimal residual disease [MRD]), next-generation targeted sequencing analysis, cell-free DNA, initial (baseline) assessment to determine a patient specific panel for future comparisons to ev ","code_information":[{"code":"0306U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3878.45,"maximum":8144.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4266.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4149.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4111.16,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4111.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3956.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3956.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4421.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4266.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4149.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4266.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4149.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3956.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4654.14,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8144.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4460.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3897.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8144.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4072.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3878.45,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8144.74,"methodology":"fee schedule"}]}]},{"description":"Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing forma ","code_information":[{"code":"81540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3750.00,"maximum":7875.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4125.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4012.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3975.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3975.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3825.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3825.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4275.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4125.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4012.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4125.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4012.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3825.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4500.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":7875.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4312.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3768.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":7875.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3937.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":7875.00,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 37.65 ","code_information":[{"code":"138","type":"RC"},{"code":"A1201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14444.24,"maximum":16724.90,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15964.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16116.73,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14444.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15204.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16724.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15204.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15964.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14444.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14748.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15204.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15204.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15204.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14900.37,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M=39-47 ","code_information":[{"code":"158","type":"RC"},{"code":"D1204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25986.94,"maximum":30090.14,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28722.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28995.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25986.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27354.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30090.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27354.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28722.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25986.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26534.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27354.67,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27354.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27354.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26807.58,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC ","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":326999.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":63111.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":64967.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":65586.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":63730.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":53109.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":71453.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":53109.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":62492.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":62492.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":80535.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":124816.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":80535.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":53109.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":65586.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":68061.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":326999.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":135384.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":326999.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":63730.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 10+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":63111.27,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":109716.39,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":115202.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":64967.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":64348.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":66204.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":60017.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":64967.48,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":65586.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":120653.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":77342.24,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":64967.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":62801.90,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":63111.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":124447.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":59213.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":61873.79,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":120653.89,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":61873.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":61873.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":62801.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":60636.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":120653.89,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 44.75 ","code_information":[{"code":"138","type":"RC"},{"code":"C0901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16068.63,"maximum":18605.78,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17760.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17929.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16068.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16914.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18605.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16914.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17760.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16068.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16406.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16914.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16914.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16914.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16576.06,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 26.75 & M < 37.15 ","code_information":[{"code":"118","type":"RC"},{"code":"A1602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15566.12,"maximum":18023.93,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17204.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17368.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15566.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16385.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18023.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16385.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17204.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15566.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15893.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16385.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16385.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16385.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16057.68,"methodology":"fee schedule"}]}]},{"description":"Phentolaine mesylate inj ","code_information":[{"code":"1458","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":367.12,"maximum":770.95,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":403.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":392.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":389.15,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":389.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":374.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":374.46,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":418.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":403.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":392.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":403.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":392.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":374.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":440.55,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":770.95,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":422.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":368.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":770.95,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":385.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":367.12,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":770.95,"methodology":"fee schedule"}]}]},{"description":"Platelet pheresis irradia ","code_information":[{"code":"9502","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":559.94,"maximum":1175.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":615.93,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":599.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":593.54,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":593.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":571.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":571.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":638.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":615.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":599.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":615.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":599.14,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":571.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":671.93,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1175.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":643.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":562.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1175.87,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":587.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":559.94,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1175.87,"methodology":"fee schedule"}]}]},{"description":"PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.00,"maximum":287.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":156.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":287.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":287.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":287.70,"methodology":"fee schedule"}]}]},{"description":"PTEN (Phosphatase and tensin monolog) full gene analysis, including small sequence changes in exonic and intronic regions, deletions, duplications, mobile element insertions and variants in non-unique ","code_information":[{"code":"0235U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600.00,"maximum":1260.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":684.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":603.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 39.05 & M < 49.25 ","code_information":[{"code":"138","type":"RC"},{"code":"B1502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26978.60,"maximum":31238.38,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29818.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30102.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26978.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28398.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31238.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28398.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29818.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26978.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27546.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28398.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28398.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28398.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27830.56,"methodology":"fee schedule"}]}]},{"description":"Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the ","code_information":[{"code":"97168","type":"CPT"},{"code":"T000063102","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":66.11,"maximum":143.12,"gross_charge":490.50,"discounted_cash":490.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":74.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":72.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":72.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":69.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":69.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":77.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":74.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":72.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":74.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":72.92,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":69.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":66.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":81.78,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":143.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":78.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":68.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":143.12,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":71.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":68.15,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":143.12,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"148","type":"RC"},{"code":"B0803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25611.31,"maximum":29655.20,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28307.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28576.82,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25611.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26959.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29655.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26959.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28307.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25611.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26150.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26959.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26959.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26959.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26420.08,"methodology":"fee schedule"}]}]},{"description":"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC ","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":48675.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8913.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9175.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9263.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9001.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20711.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27865.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20711.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8826.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8826.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":31406.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":48675.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":31406.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20711.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9263.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9612.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":43465.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":17995.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":43465.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9001.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8913.72,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14583.87,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":15313.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9175.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9088.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9350.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8476.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9175.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9263.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":17040.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10923.68,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9175.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8870.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8913.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8363.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8738.94,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":17040.94,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8738.94,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8738.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8870.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8564.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":17040.94,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M < 26.15 ","code_information":[{"code":"118","type":"RC"},{"code":"B1303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28310.83,"maximum":32780.97,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31290.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31588.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28310.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29800.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32780.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29800.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31290.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28310.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28906.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29800.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29800.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29800.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29204.86,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"A1301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":13365.76,"maximum":15476.14,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14772.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14913.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13365.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14069.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15476.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14069.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14772.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13365.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13647.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14069.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14069.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14069.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13787.84,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"148","type":"RC"},{"code":"C1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29561.27,"maximum":34228.83,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32672.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32984.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29561.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31117.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34228.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31117.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32672.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29561.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30183.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31117.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31117.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31117.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30494.78,"methodology":"fee schedule"}]}]},{"description":"Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger) ","code_information":[{"code":"89322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.05,"maximum":32.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":32.55,"methodology":"fee schedule"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY ","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":129581.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":42818.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43732.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":42818.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":34896.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45018.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":45447.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":44161.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":75543.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":122728.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":75543.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43303.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43303.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":102649.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":129581.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":102649.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":75543.00,"methodology":"case rate"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":45447.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47162.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31691.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":44161.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":43732.27,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":75700.59,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":79485.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45018.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":44589.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":45876.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":41588.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45018.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":45447.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":83605.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":53593.46,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":45018.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":43517.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43732.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":111887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":41031.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42874.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":83605.80,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":42874.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":42874.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":43517.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42017.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":83605.80,"methodology":"fee schedule"}]}]},{"description":"Streptozocin injection ","code_information":[{"code":"850","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":370.18,"maximum":777.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":407.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":396.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":392.40,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":392.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":377.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":377.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":422.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":407.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":396.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":407.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":396.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":377.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":444.22,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":777.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":425.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":372.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":777.39,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":388.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":370.18,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":777.39,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"148","type":"RC"},{"code":"D0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27037.03,"maximum":31306.04,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29883.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30167.63,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27037.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31306.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29883.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27037.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27606.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28460.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27890.83,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C > 18.5 ","code_information":[{"code":"128","type":"RC"},{"code":"D0102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16435.91,"maximum":19031.05,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18166.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18339.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16435.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17300.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19031.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17300.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18166.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16435.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16781.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17300.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17300.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17300.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16954.94,"methodology":"fee schedule"}]}]},{"description":"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage t ","code_information":[{"code":"97130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.53,"maximum":44.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":44.44,"methodology":"fee schedule"}]}]},{"description":"Thromboplastin time, partial (PTT); substitution, plasma fractions, each ","code_information":[{"code":"85732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.87,"maximum":13.59,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13.59,"methodology":"fee schedule"}]}]},{"description":"Transplantation medicine (allograft rejection, pediatric liver and small bowel), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorith ","code_information":[{"code":"81560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":580.74,"maximum":1345.53,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":704.80,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":685.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":679.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":679.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":730.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":704.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":685.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":704.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":685.58,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":580.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":768.88,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1345.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":736.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":643.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1345.53,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":672.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1345.53,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & C < 23.5 ","code_information":[{"code":"158","type":"RC"},{"code":"B0203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27726.52,"maximum":32104.39,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30645.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30936.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27726.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29185.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32104.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29185.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30645.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27726.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28310.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29185.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29185.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29185.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28602.10,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"138","type":"RC"},{"code":"C0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35982.04,"maximum":41663.41,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39769.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40148.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35982.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37875.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41663.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37875.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39769.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35982.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36739.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37875.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37875.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37875.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37118.31,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 16.05 & M < 30.3 ","code_information":[{"code":"128","type":"RC"},{"code":"D0403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28130.53,"maximum":32572.20,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31091.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31387.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28130.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32572.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31091.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28130.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28722.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29018.86,"methodology":"fee schedule"}]}]},{"description":"Treprostinil injection ","code_information":[{"code":"1701","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":55.81,"maximum":117.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":61.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":59.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":59.16,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":59.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":63.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":61.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":59.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":61.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":59.72,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":66.98,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":117.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":56.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":117.21,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":117.21,"methodology":"fee schedule"}]}]},{"description":"Vaccinia vrs vac 0.3 ml p ","code_information":[{"code":"9101","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.01,"maximum":0.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":0.02,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":0.02,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITH CC ","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":93573.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18491.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19035.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19217.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18673.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":24920.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":33527.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":24920.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18310.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18310.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":37789.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58566.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":37789.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":24920.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19217.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19942.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":93573.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":38741.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":93573.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18673.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18491.83,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31396.26,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":32966.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19035.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18854.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19398.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17585.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19035.71,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19217.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35352.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22661.56,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19035.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18401.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18491.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17349.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18129.25,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35352.04,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18129.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18129.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18401.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17766.67,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35352.04,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M < 36.25 ","code_information":[{"code":"158","type":"RC"},{"code":"B1003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30007.01,"maximum":34744.96,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33165.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33481.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30007.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31586.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34744.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31586.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33165.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30007.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30638.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31586.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31586.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31586.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30954.60,"methodology":"fee schedule"}]}]},{"description":"\"Nephrology (renal transplant), RNA expression by select transcriptome sequencing, using pretransplant peripheral blood, algorithm reported as a risk scorefor early acute rejection\" ","code_information":[{"code":"0319U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2650.00,"maximum":5565.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2915.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2835.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2809.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2809.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2703.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2703.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3021.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2915.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2835.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2915.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2835.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2703.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3180.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5565.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3047.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2663.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5565.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2782.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5565.00,"methodology":"fee schedule"}]}]},{"description":"AFF2 (ALF transcription elongation factor 2 ºFMR2») (eg, fragile X intellectual disability 2 ºFRAXE») gene analysis; evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.00,"maximum":287.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":156.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":287.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":287.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":287.70,"methodology":"fee schedule"}]}]},{"description":"Aminolevulinic acid, 10% ","code_information":[{"code":"9301","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.72,"maximum":3.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.84,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3.62,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 36.25 & M < 47.65 ","code_information":[{"code":"128","type":"RC"},{"code":"A1002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17334.08,"maximum":20071.04,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19158.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19341.19,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17334.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20071.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19158.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17334.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17699.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18246.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17881.48,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M > 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"D1101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16976.82,"maximum":19657.37,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18763.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18942.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16976.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19657.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18763.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16976.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17334.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17512.93,"methodology":"fee schedule"}]}]},{"description":"Antibody; encephalitis, Eastern equine ","code_information":[{"code":"86652","type":"CPT"},{"code":"L000289602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.95,"maximum":27.70,"gross_charge":156.65,"discounted_cash":156.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.70,"methodology":"fee schedule"}]}]},{"description":"Antibody; Trichinella ","code_information":[{"code":"86784","type":"CPT"},{"code":"L000317002","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.39,"maximum":26.38,"gross_charge":115.85,"discounted_cash":115.85,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26.38,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; whirlpool ","code_information":[{"code":"97022","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":14.00,"maximum":29.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":29.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":29.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":29.40,"methodology":"fee schedule"}]}]},{"description":"BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative ","code_information":[{"code":"81207","type":"CPT"},{"code":"L000048101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":144.84,"maximum":304.16,"gross_charge":621.55,"discounted_cash":621.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":154.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":153.53,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":153.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":165.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":154.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":154.98,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":173.81,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":304.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":166.57,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":304.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":152.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":304.16,"methodology":"fee schedule"}]}]},{"description":"Brachytx, non-stranded, N ","code_information":[{"code":"2699","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":34.95,"maximum":73.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":39.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":73.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":73.40,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":73.40,"methodology":"fee schedule"}]}]},{"description":"Calcium; ionized ","code_information":[{"code":"82330","type":"CPT"},{"code":"L000090801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.40,"maximum":28.73,"gross_charge":279.50,"discounted_cash":279.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.73,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.73,"methodology":"fee schedule"}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC ","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":77003.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15324.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15775.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15925.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":22410.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15474.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20583.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27692.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20583.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15174.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15174.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":31212.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":48373.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":31212.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20583.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15925.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16526.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":77003.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31881.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":77003.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15474.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15324.53,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25836.72,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":27128.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15775.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15625.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16075.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14573.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15775.25,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15925.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":29296.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18780.06,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15775.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15249.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15324.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":34861.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14378.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15024.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":29296.90,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15024.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15024.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15249.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14723.57,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":29296.90,"methodology":"fee schedule"}]}]},{"description":"Alpha 1 proteinase inhibi ","code_information":[{"code":"901","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.93,"maximum":10.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10.36,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 36.25 & M < 47.65 ","code_information":[{"code":"158","type":"RC"},{"code":"C1002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21180.54,"maximum":24524.83,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23410.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23633.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21180.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22295.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24524.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22295.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23410.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21180.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21626.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22295.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22295.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22295.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21849.40,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"118","type":"RC"},{"code":"B1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26850.05,"maximum":31089.53,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29676.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29959.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26850.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31089.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29676.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26850.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27415.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28263.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27697.95,"methodology":"fee schedule"}]}]},{"description":"Androstanediol glucuronide ","code_information":[{"code":"82154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26.13,"maximum":60.54,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30.56,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":30.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.85,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":26.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":60.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":60.54,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":60.54,"methodology":"fee schedule"}]}]},{"description":"Antibody; Bordetella ","code_information":[{"code":"86615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.95,"maximum":27.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.70,"methodology":"fee schedule"}]}]},{"description":"Antibody; Rickettsia ","code_information":[{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.54,"maximum":40.64,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":40.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":40.64,"methodology":"fee schedule"}]}]},{"description":"Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with wr ","code_information":[{"code":"97755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36.44,"maximum":78.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.82,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":39.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":42.83,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.20,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":36.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":78.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":78.90,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":78.90,"methodology":"fee schedule"}]}]},{"description":"Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content ºCHr», immature reticulocyte fraction ºIRF», reticulocyte volume ºMRV», RNA content) ","code_information":[{"code":"85046","type":"CPT"},{"code":"L000200001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.04,"maximum":11.70,"gross_charge":11.60,"discounted_cash":11.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.90,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11.70,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"148","type":"RC"},{"code":"B2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":38691.59,"maximum":44800.78,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":42764.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43171.66,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":38691.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44800.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":42764.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":38691.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":39506.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":40727.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39913.42,"methodology":"fee schedule"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC ","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52837.27,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10705.06,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11019.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11124.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10810.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8711.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11719.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8711.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10600.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10600.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13209.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20472.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13209.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8711.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11124.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11544.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52837.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21875.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52837.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10810.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10705.06,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17728.20,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":18614.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11019.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10914.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11229.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10180.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11019.92,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11124.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20465.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13118.95,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11019.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10652.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10705.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10043.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10495.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20465.56,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10495.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10495.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10652.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10285.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20465.56,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 38.55 & M < 48.85 ","code_information":[{"code":"158","type":"RC"},{"code":"B1402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23893.42,"maximum":27666.07,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26408.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26660.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23893.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25150.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27666.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25150.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26408.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23893.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24396.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25150.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25150.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25150.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24647.95,"methodology":"fee schedule"}]}]},{"description":"Catecholamines; fractionated ","code_information":[{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.88,"maximum":53.03,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.30,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":53.03,"methodology":"fee schedule"}]}]},{"description":"Chlorinated hydrocarbons, screen ","code_information":[{"code":"82441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.45,"maximum":12.62,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"Clotting; high molecular weight kininogen assay (Fitzgerald factor assay) ","code_information":[{"code":"85293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.16,"maximum":39.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.07,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":39.75,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":39.75,"methodology":"fee schedule"}]}]},{"description":"Conivaptan hcl ","code_information":[{"code":"9488","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":47.24,"maximum":99.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":50.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":53.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":51.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":48.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":56.69,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":99.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":54.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":47.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":99.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":49.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":47.24,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":99.20,"methodology":"fee schedule"}]}]},{"description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood ","code_information":[{"code":"87103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.55,"maximum":42.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.55,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.46,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42.97,"methodology":"fee schedule"}]}]},{"description":"Daratumumab, hyaluronidas ","code_information":[{"code":"9378","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":51.41,"maximum":107.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":55.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.50,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":54.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":58.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":55.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":55.01,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":52.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":59.12,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":107.96,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":107.96,"methodology":"fee schedule"}]}]},{"description":"Dimecaprol injection ","code_information":[{"code":"9039","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":59.81,"maximum":125.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":63.40,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":63.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":61.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":61.01,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":68.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":61.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":71.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":125.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":68.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":60.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":125.60,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":62.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":125.60,"methodology":"fee schedule"}]}]},{"description":"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC ","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":100500.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19815.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20398.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20592.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20010.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10459.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14072.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10459.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19621.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19621.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15860.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24581.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15860.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10459.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20592.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21370.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":100500.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":41609.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":100500.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20010.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19815.88,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":33720.33,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":35406.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20398.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20204.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20787.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18844.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20398.70,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":20592.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":37883.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24284.16,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":20398.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19718.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19815.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18591.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19427.33,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":37883.29,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":19427.33,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":19427.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19718.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19038.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":37883.29,"methodology":"fee schedule"}]}]},{"description":"Etiocholanolone ","code_information":[{"code":"82696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.78,"maximum":55.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Factor ix complex ","code_information":[{"code":"928","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.65,"maximum":3.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3.47,"methodology":"fee schedule"}]}]},{"description":"Flecainide ","code_information":[{"code":"80181","type":"CPT"},{"code":"L000004602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.90,"maximum":39.14,"gross_charge":9.65,"discounted_cash":9.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":39.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":39.14,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"118","type":"RC"},{"code":"A0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21532.80,"maximum":24932.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23799.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24026.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21532.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24932.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23799.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21532.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21986.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22666.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22212.78,"methodology":"fee schedule"}]}]},{"description":"Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for anti-CdtB and anti-vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results ","code_information":[{"code":"0164U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112.02,"maximum":235.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":123.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":119.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":118.74,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":118.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":114.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":114.26,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":127.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":123.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":119.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":123.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":119.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":114.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":134.42,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":235.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":128.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":112.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":235.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":117.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":235.24,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M < 18.05 ","code_information":[{"code":"138","type":"RC"},{"code":"C1903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32232.41,"maximum":37321.74,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35625.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35964.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32232.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33928.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37321.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33928.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35625.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32232.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32910.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33928.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33928.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33928.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33250.28,"methodology":"fee schedule"}]}]},{"description":"HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence ","code_information":[{"code":"81259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600.00,"maximum":1260.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":684.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":603.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1260.00,"methodology":"fee schedule"}]}]},{"description":"Hematology (genetic platelet function disorder), genomic sequence analysis of 31 genes, blood, buccal swab, or amniotic fluid ","code_information":[{"code":"0277U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":608.17,"maximum":1277.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":693.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":729.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1277.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":699.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":611.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1277.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":638.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1277.16,"methodology":"fee schedule"}]}]},{"description":"Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alani ","code_information":[{"code":"80076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.40,"maximum":17.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":17.16,"methodology":"fee schedule"}]}]},{"description":"Hydroxyprogesterone, 17-d ","code_information":[{"code":"83498","type":"CPT"},{"code":"L000126202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.63,"maximum":57.06,"gross_charge":28.15,"discounted_cash":28.15,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":57.06,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":57.06,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":25.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.16,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique ","code_information":[{"code":"87480","type":"CPT"},{"code":"L000364802","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":18.17,"maximum":42.11,"gross_charge":86.05,"discounted_cash":86.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.06,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42.11,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA/RNA), vaginal pathogen panel, identification of 27 organisms, amplified probe technique, vaginal swab ","code_information":[{"code":"0330U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":416.78,"maximum":875.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":441.79,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":441.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":475.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":500.14,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":875.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":479.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":418.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":875.24,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":437.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":875.24,"methodology":"fee schedule"}]}]},{"description":"Inj mvasi 10 mg ","code_information":[{"code":"9329","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":26.59,"maximum":55.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.45,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.90,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":55.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":55.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":55.83,"methodology":"fee schedule"}]}]},{"description":"Inj, cabote rilpivir 2mg ","code_information":[{"code":"9414","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":22.90,"maximum":48.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":24.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.36,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":23.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":48.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":48.09,"methodology":"fee schedule"}]}]},{"description":"Inj, nogapendekin pmln 1 ","code_information":[{"code":"767","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":92.19,"maximum":193.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":101.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":98.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":97.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":94.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":94.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":105.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":101.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":98.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":101.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":98.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":94.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":110.62,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":106.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":92.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":193.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":96.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":92.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":193.59,"methodology":"fee schedule"}]}]},{"description":"Inj. teprotumumab-trbw 10 ","code_information":[{"code":"9355","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":343.88,"maximum":722.16,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":367.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":364.52,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":364.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":350.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":350.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":392.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":367.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":378.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":367.96,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":350.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":412.66,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":722.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":395.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":345.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":722.16,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":361.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":343.88,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":722.16,"methodology":"fee schedule"}]}]},{"description":"Inj., trazimera, 10 mg ","code_information":[{"code":"9350","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":19.17,"maximum":40.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":40.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":40.26,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":40.26,"methodology":"fee schedule"}]}]},{"description":"KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor ºGIST», acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons ","code_information":[{"code":"81272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":329.51,"maximum":691.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":362.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":352.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":349.28,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":349.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":336.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":336.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":375.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":362.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":352.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":362.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":352.58,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":336.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":395.41,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":691.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":378.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":331.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":691.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":345.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":691.97,"methodology":"fee schedule"}]}]},{"description":"Level 1 Nuclear Medicine ","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":379.67,"maximum":797.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":402.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":402.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":387.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":387.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":432.83,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":387.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":455.61,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":797.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":436.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":381.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":797.31,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":398.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":797.31,"methodology":"fee schedule"}]}]},{"description":"Level 3 Lower GI Procedur ","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2584.71,"maximum":5427.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2843.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2765.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2739.79,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2739.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2636.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2636.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2946.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2843.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2765.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2843.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2765.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2636.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3101.65,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5427.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2972.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2597.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5427.89,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2713.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2584.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5427.89,"methodology":"fee schedule"}]}]},{"description":"Level 4 Vascular Procedur ","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5058.74,"maximum":10623.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5564.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5412.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5362.26,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5362.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5159.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5159.91,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5766.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5564.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5412.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5564.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5412.85,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5159.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6070.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":10623.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5817.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5084.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":10623.35,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5311.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5058.74,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":10623.35,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"118","type":"RC"},{"code":"A1703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21524.45,"maximum":24923.05,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23790.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24016.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21524.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22657.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24923.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22657.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23790.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21524.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21977.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22657.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22657.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22657.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22204.17,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"148","type":"RC"},{"code":"D1703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23724.81,"maximum":27470.83,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26222.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26471.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23724.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27470.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26222.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23724.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24224.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24973.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24474.01,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"128","type":"RC"},{"code":"B1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33365.98,"maximum":38634.30,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36878.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37229.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33365.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38634.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36878.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33365.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34068.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35122.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34419.65,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 49.15 ","code_information":[{"code":"128","type":"RC"},{"code":"C2001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15741.41,"maximum":18226.90,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17398.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17564.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15741.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18226.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17398.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15741.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16072.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16238.51,"methodology":"fee schedule"}]}]},{"description":"MSH6 (mutS homolog 6 ºE. coli») (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants ","code_information":[{"code":"81299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":308.00,"maximum":646.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":338.80,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":329.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":351.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":338.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":329.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":338.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":329.56,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":369.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":646.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":354.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":309.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":646.80,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":323.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":646.80,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M < 25.85 ","code_information":[{"code":"128","type":"RC"},{"code":"B0604","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":41576.43,"maximum":48141.12,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45952.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46390.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":41576.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43764.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":48141.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":43764.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45952.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":41576.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42451.72,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":43764.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":43764.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":43764.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42889.37,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 25.85 & M < 37.35 ","code_information":[{"code":"158","type":"RC"},{"code":"C0603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24819.98,"maximum":28738.92,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27432.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27693.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24819.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26126.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28738.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26126.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27432.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24819.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25342.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26126.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26126.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26126.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25603.77,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 19 ","code_information":[{"code":"1519","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1691.26,"maximum":3551.65,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1860.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1809.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1792.74,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1792.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1725.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1725.09,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1928.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1860.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1809.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1860.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1809.65,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1725.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2029.52,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3551.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1944.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1699.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3551.65,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1775.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1691.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3551.65,"methodology":"fee schedule"}]}]},{"description":"Nitroblue tetrazolium dye test (NTD) ","code_information":[{"code":"86384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.34,"maximum":28.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.58,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"158","type":"RC"},{"code":"A0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":13861.59,"maximum":16050.26,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15320.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15466.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13861.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14591.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16050.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14591.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15320.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13861.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14153.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14591.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14591.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14591.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14299.33,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 40.15 & M < 5 ","code_information":[{"code":"128","type":"RC"},{"code":"A0502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18011.89,"maximum":20855.87,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19907.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20097.47,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18011.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20855.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19907.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18011.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18391.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18580.68,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"158","type":"RC"},{"code":"D0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15581.14,"maximum":18041.32,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17221.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17385.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15581.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18041.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17221.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15581.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15909.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16073.18,"methodology":"fee schedule"}]}]},{"description":"Oncology (high-grade prostate cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2 ºhK2»), utilizing plasma or serum, prognostic algorithm reported as a ","code_information":[{"code":"81539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":760.00,"maximum":1596.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":866.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1596.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1596.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1596.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid tumor), gene expression profiling by real-time RT-PCR of 7 gene pathways (ER, AR, PI3K, MAPK, HH, TGFB, Notch), formalin-fixed paraffin-embedded (FFPE), algorithm reported as gene path ","code_information":[{"code":"0262U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3200.00,"maximum":6720.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3520.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3424.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3392.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3392.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3264.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3264.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3648.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3520.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3424.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3520.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3424.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3264.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3840.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6720.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3680.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3216.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6720.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3360.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3200.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6720.00,"methodology":"fee schedule"}]}]},{"description":"Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minu ","code_information":[{"code":"97760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44.54,"maximum":96.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":52.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":50.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":96.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":52.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":46.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":96.43,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":48.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":45.92,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":96.43,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M=39-47 ","code_information":[{"code":"138","type":"RC"},{"code":"B1204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36456.17,"maximum":42212.41,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40293.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40677.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36456.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42212.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40293.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36456.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37223.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38374.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37607.42,"methodology":"fee schedule"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":33227.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6630.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6825.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6890.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6695.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14138.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19021.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14138.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6565.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6565.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":21439.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":33227.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21439.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14138.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6890.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7150.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":31522.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13051.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":31522.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6695.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6630.79,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10576.65,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":11105.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6825.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6760.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6955.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6305.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6825.81,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6890.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":12676.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8125.96,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6825.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6598.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6630.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6221.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6500.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":12676.50,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6500.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6500.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6598.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6370.75,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":12676.50,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 34.35 & M < 44.75 ","code_information":[{"code":"138","type":"RC"},{"code":"B0902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24986.92,"maximum":28932.23,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27617.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27880.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24986.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26302.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28932.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26302.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27617.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24986.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25512.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26302.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26302.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26302.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25775.99,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"158","type":"RC"},{"code":"C1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23494.42,"maximum":27204.07,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25967.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26214.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23494.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24730.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27204.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24730.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25967.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23494.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23989.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24730.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24730.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24730.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24236.35,"methodology":"fee schedule"}]}]},{"description":"Pediatrics (congenital epigenetic disorders), whole genome methylation analysis by microarray for 50 or more genes, blood ","code_information":[{"code":"0318U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1770.48,"maximum":3718.01,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1947.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1894.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1876.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1876.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1805.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1805.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":2018.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1947.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1894.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1947.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1894.41,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1805.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2124.58,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3718.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2036.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1779.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3718.01,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1859.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3718.01,"methodology":"fee schedule"}]}]},{"description":"Phenylketones, qualitative ","code_information":[{"code":"84035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.61,"maximum":8.36,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.98,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8.36,"methodology":"fee schedule"}]}]},{"description":"Pneumococcal, Influenza, ","code_information":[{"code":"9399","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":35.60,"maximum":74.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":39.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":38.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":37.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":39.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":39.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38.10,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.72,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":74.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":74.77,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":74.77,"methodology":"fee schedule"}]}]},{"description":"PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant ","code_information":[{"code":"81323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":300.00,"maximum":630.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":330.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":321.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":318.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":318.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":306.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":306.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":342.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":330.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":321.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":330.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":321.00,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":306.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":360.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":345.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":301.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":315.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":630.00,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 49.25 ","code_information":[{"code":"128","type":"RC"},{"code":"B1501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21267.35,"maximum":24625.35,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23506.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23729.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21267.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22386.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24625.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22386.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23506.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21267.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21715.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22386.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22386.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22386.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21938.95,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (MNS blood group) genotyping (GYPA), gene analysis, GYPA (flycophorin A) introns 1, 5, exon 2 ","code_information":[{"code":"0189U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274.83,"maximum":577.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":313.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":577.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":577.14,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":577.14,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 22.05 & ","code_information":[{"code":"148","type":"RC"},{"code":"C0805","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27613.00,"maximum":31972.94,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30810.29,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27613.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29066.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31972.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29066.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30519.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27613.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28194.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29066.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29066.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29066.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28484.99,"methodology":"fee schedule"}]}]},{"description":"Reptilase test ","code_information":[{"code":"85635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.92,"maximum":20.68,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":20.68,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"158","type":"RC"},{"code":"B1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35753.32,"maximum":41398.58,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39516.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39893.18,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35753.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37635.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41398.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37635.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39516.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35753.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36506.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37635.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37635.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37635.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36882.37,"methodology":"fee schedule"}]}]},{"description":"SIGNS AND SYMPTOMS WITH MCC ","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":56346.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11375.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11710.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11821.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11487.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8510.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11450.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8510.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11264.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11264.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12906.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20002.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12906.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8510.99,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11821.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12268.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":56346.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23328.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":56346.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11487.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11375.88,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18905.67,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":19850.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11710.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11598.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11933.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10818.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11710.46,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11821.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21748.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13941.02,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11710.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11320.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11375.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10673.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11152.82,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21748.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11152.82,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11152.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11320.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10929.76,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21748.00,"methodology":"fee schedule"}]}]},{"description":"SOFT TISSUE PROCEDURES WITH MCC ","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":138818.32,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27140.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27938.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28204.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":27406.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9403.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12651.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9403.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26874.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26874.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14260.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22100.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14260.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9403.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28204.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29269.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":138818.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":57473.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":138818.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27406.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27140.36,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":46576.95,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":48905.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27938.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27672.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28470.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25809.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27938.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":28204.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":51885.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33260.25,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":27938.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27007.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27140.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25464.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26608.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":51885.99,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26608.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26608.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27007.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26076.04,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":51885.99,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C < 18.5 ","code_information":[{"code":"118","type":"RC"},{"code":"D0103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21185.55,"maximum":24530.63,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23415.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23638.61,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21185.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22300.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24530.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22300.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23415.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21185.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21631.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22300.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22300.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22300.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21854.56,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 51.05 ","code_information":[{"code":"128","type":"RC"},{"code":"B0101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16344.09,"maximum":18924.74,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18064.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18236.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16344.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17204.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18924.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17204.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18064.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16344.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16688.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17204.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17204.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17204.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16860.22,"methodology":"fee schedule"}]}]},{"description":"T cells; total count ","code_information":[{"code":"86359","type":"CPT"},{"code":"L000269102","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":34.19,"maximum":79.23,"gross_charge":30.30,"discounted_cash":30.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":43.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":79.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":79.23,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":79.23,"methodology":"fee schedule"}]}]},{"description":"Thyrotropin releasing hormone (TRH) stimulation panel; 1 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 3) ","code_information":[{"code":"80438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45.69,"maximum":105.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":53.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":53.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":53.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":53.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":45.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60.49,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":105.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":57.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":50.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":105.86,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":105.86,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"148","type":"RC"},{"code":"C0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36279.20,"maximum":42007.50,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40098.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40479.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36279.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42007.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40098.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36279.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37042.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38188.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37424.86,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"118","type":"RC"},{"code":"A0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31738.25,"maximum":36749.55,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35079.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35413.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":31738.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33408.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36749.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33408.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35079.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31738.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32406.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33408.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33408.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33408.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32740.51,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 16.05 & M < 30.3 ","code_information":[{"code":"118","type":"RC"},{"code":"D0403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28130.53,"maximum":32572.20,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31091.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31387.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28130.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32572.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31091.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28130.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28722.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29611.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29018.86,"methodology":"fee schedule"}]}]},{"description":"Tyrosine ","code_information":[{"code":"84510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.63,"maximum":22.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.37,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":22.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":22.32,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":22.32,"methodology":"fee schedule"}]}]},{"description":"Ustekinumab, iv inject,1 ","code_information":[{"code":"9487","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":12.97,"maximum":27.23,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27.23,"methodology":"fee schedule"}]}]},{"description":"Vitamin, not otherwise specified ","code_information":[{"code":"84591","type":"CPT"},{"code":"L000194602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.46,"maximum":35.83,"gross_charge":73.20,"discounted_cash":73.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.25,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.47,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.06,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35.83,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"138","type":"RC"},{"code":"C0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23716.46,"maximum":27461.16,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26212.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26462.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23716.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24964.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27461.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24964.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26212.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23716.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24215.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24964.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24964.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24964.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24465.40,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"128","type":"RC"},{"code":"D0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15581.14,"maximum":18041.32,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17221.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17385.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15581.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18041.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17221.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15581.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15909.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16401.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16073.18,"methodology":"fee schedule"}]}]},{"description":"Oncology (Bladder), analysis of 10 protein biomarkers by immunoassays, urine, diagnostic algorithm reported as a risk score for probability of rapid recurrence of recurrent or persistent cancer follow ","code_information":[{"code":"0367U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":902.18,"maximum":1894.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":992.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":965.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":956.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":956.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":920.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":920.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1028.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":992.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":965.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":992.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":965.33,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":920.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1082.62,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1894.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1037.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":906.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1894.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":947.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":902.18,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1894.58,"methodology":"fee schedule"}]}]},{"description":"Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score ","code_information":[{"code":"81500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260.50,"maximum":547.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":286.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":278.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":276.13,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":276.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":296.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":286.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":278.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":286.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":278.74,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":312.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":547.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":299.57,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":261.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":547.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":273.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":547.05,"methodology":"fee schedule"}]}]},{"description":"Oncology, response to radiation, cell-free DNA, quantitative branched chain DNA amplfication, plasma, reported as a radiation toxicity score ","code_information":[{"code":"0285U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":443.31,"maximum":930.95,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":474.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":469.91,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":469.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":452.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":452.18,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":505.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":474.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":487.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":474.34,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":452.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":531.97,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":930.95,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":509.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":445.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":930.95,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":465.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":443.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":930.95,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"158","type":"RC"},{"code":"C1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20400.90,"maximum":23622.09,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22548.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22763.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20400.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21474.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23622.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21474.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22548.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20400.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20830.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21474.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21474.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21474.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21045.14,"methodology":"fee schedule"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT ","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":57122.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11524.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11863.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11976.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11637.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6433.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8655.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6433.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11411.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11411.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9756.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":15120.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9756.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6433.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11976.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12427.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":57122.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23649.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":57122.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11637.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11524.11,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19165.86,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":20124.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11863.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11750.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12089.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10959.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11863.06,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11976.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":22031.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14122.69,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11863.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11467.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11524.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10812.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11298.15,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":22031.39,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11298.15,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11298.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11467.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11072.19,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":22031.39,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M < 24.15 ","code_information":[{"code":"148","type":"RC"},{"code":"A0904","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24420.97,"maximum":28276.92,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26991.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27248.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24420.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25706.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28276.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25706.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26991.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24420.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24935.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25706.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25706.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25706.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25192.16,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 44.75 ","code_information":[{"code":"148","type":"RC"},{"code":"B0901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20061.99,"maximum":23229.68,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22173.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22384.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20061.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21117.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23229.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21117.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22173.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20061.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20484.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21117.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21117.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21117.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20695.53,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 26.75 & M < 37.15 ","code_information":[{"code":"158","type":"RC"},{"code":"B1602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25047.03,"maximum":29001.82,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27683.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27947.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25047.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26365.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29001.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26365.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27683.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25047.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25574.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26365.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26365.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26365.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25837.98,"methodology":"fee schedule"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH MCC ","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52886.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":29292.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14152.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":29292.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":23873.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14569.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14707.93,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":22410.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14291.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8834.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11885.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8834.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14014.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14014.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13396.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20761.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13396.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8834.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14707.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15262.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52886.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21896.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52886.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14291.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14152.92,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23780.19,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":24969.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14569.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14430.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14846.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13459.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14569.18,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14707.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27057.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17344.26,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14569.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14083.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14152.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26613.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13278.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13875.41,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27057.05,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13875.41,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13875.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14083.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13597.90,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27057.05,"methodology":"fee schedule"}]}]},{"description":"Placental alpha-micro globulin-1 (PAMG-1), immunoassay with direct optical observation, cervico-vaginal fluid, each specimen ","code_information":[{"code":"0066U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.29,"maximum":32.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":32.11,"methodology":"fee schedule"}]}]},{"description":"Potassium; urine ","code_information":[{"code":"84133","type":"CPT"},{"code":"L000176201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.29,"maximum":9.93,"gross_charge":307.35,"discounted_cash":307.35,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9.93,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M < 29.15 ","code_information":[{"code":"128","type":"RC"},{"code":"A1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27112.16,"maximum":31393.02,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29966.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30251.46,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27112.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28539.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31393.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28539.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29966.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27112.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27682.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28539.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28539.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28539.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27968.33,"methodology":"fee schedule"}]}]},{"description":"Radiation treatment deliv ","code_information":[{"code":"4009","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":160.67,"maximum":337.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":176.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":171.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":170.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":170.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":183.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":176.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":171.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":176.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":171.92,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":192.81,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":337.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":184.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":161.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":337.41,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":168.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":337.41,"methodology":"fee schedule"}]}]},{"description":"Red blood cell antigen typing, DNA, genotyping of 10 blood groups with phenotype pdediction of 37 red blood cell antigens ","code_information":[{"code":"0084U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":652.59,"maximum":1512.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":770.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":763.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":763.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":820.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":770.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":770.40,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":652.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":864.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1512.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":828.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":723.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1512.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":756.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1512.00,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"148","type":"RC"},{"code":"B0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28693.14,"maximum":33223.64,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31713.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32015.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28693.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33223.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31713.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28693.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29297.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30203.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29599.24,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"148","type":"RC"},{"code":"D0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14848.25,"maximum":17192.71,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16411.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16567.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14848.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17192.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16411.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14848.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15160.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15629.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15317.14,"methodology":"fee schedule"}]}]},{"description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision ","code_information":[{"code":"G0123","type":"HCPCS"},{"code":"L000432502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":18.36,"maximum":42.55,"gross_charge":53.65,"discounted_cash":53.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42.55,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42.55,"methodology":"fee schedule"}]}]},{"description":"Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks ","code_information":[{"code":"88140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.25,"maximum":16.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.59,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":16.78,"methodology":"fee schedule"}]}]},{"description":"SPLENIC PROCEDURES WITH CC ","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":127650.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25005.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25741.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25986.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":25250.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":34784.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46798.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":34784.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24760.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24760.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":52747.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":81749.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":52747.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":34784.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25986.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26966.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":127650.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":52849.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":127650.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25250.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25005.66,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":42829.92,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":44971.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25741.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":25495.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26231.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23779.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25741.12,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":25986.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":47804.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30644.19,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":25741.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24883.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25005.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23461.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24515.35,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":47804.93,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":24515.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":24515.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24883.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24025.04,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":47804.93,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"148","type":"RC"},{"code":"C0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36997.08,"maximum":42838.72,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40891.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41280.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":36997.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42838.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40891.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36997.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37775.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38944.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38165.40,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 51.05 ","code_information":[{"code":"118","type":"RC"},{"code":"D0101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12953.40,"maximum":14998.67,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14316.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14453.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12953.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13635.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14998.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13635.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14316.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12953.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13226.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13635.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13635.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13635.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13362.46,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 37.05 & ","code_information":[{"code":"158","type":"RC"},{"code":"A0802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15699.68,"maximum":18178.57,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17352.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17517.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15699.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16525.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18178.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16525.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17352.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15699.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16030.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16525.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16525.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16525.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16195.45,"methodology":"fee schedule"}]}]},{"description":"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC ","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":93936.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":40134.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43268.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":40134.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":32708.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":44540.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":44965.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":46348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":21659.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":42555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":43692.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":26582.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":35763.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":26582.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":42844.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":42844.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":40309.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":62472.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":40309.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":26582.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":44965.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":46661.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31691.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43692.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":43268.31,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":74886.21,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":78630.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":44540.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":44116.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":45389.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":41147.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":44540.91,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":44965.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":82718.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":53024.89,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":44540.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":43056.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43268.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":93936.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":40595.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42419.91,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":82718.82,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":42419.91,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":42419.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":43056.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":41571.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":82718.82,"methodology":"fee schedule"}]}]},{"description":"Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptiv ","code_information":[{"code":"97535","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":26.98,"maximum":56.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.60,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":28.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.37,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":56.66,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":56.66,"methodology":"fee schedule"}]}]},{"description":"Sialic acid ","code_information":[{"code":"84275","type":"CPT"},{"code":"L000184902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.18,"maximum":28.22,"gross_charge":25.75,"discounted_cash":25.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.22,"methodology":"fee schedule"}]}]},{"description":"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":69810.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13949.42,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14359.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14496.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14086.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19167.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25787.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19167.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13812.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13812.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29065.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":45046.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29065.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19167.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14496.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15043.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":69810.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28902.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":69810.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14086.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13949.42,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23422.98,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":24594.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14359.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14222.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14633.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13265.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14359.69,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14496.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":26668.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17094.88,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14359.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13881.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13949.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13087.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13675.90,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":26668.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13675.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13675.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13881.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13402.38,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":26668.00,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"148","type":"RC"},{"code":"A0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25766.57,"maximum":29834.97,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28478.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28750.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25766.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27122.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29834.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27122.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28478.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25766.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26309.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27122.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27122.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27122.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26580.25,"methodology":"fee schedule"}]}]},{"description":"Surrogate viral neutralization test (sVNT), severe acute respiratory s yndrome coronavirus 2 (SARS-CoV-2) (Corornavirus disease (COVID-19)), ( ELISA, plasma, serum ","code_information":[{"code":"0226U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38.32,"maximum":88.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":44.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":48.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":46.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.24,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":88.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":48.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":88.79,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.28,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":88.79,"methodology":"fee schedule"}]}]},{"description":"Thromboplastin time, partial (PTT); plasma or whole blood ","code_information":[{"code":"85730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.45,"maximum":12.62,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"Tisagenlecleucel car-pos ","code_information":[{"code":"9194","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":529192.90,"maximum":1111305.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":582112.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":566236.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":560944.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":560944.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":539776.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":539776.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":603279.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":582112.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":566236.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":582112.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":566236.40,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":539776.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":635031.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1111305.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":608571.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":531838.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1111305.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":555652.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":529192.90,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1111305.09,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & C < 23.5 ","code_information":[{"code":"138","type":"RC"},{"code":"D0203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20741.47,"maximum":24016.44,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22924.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23143.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20741.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24016.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22924.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20741.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21178.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21833.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21396.46,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 16.05 & M < 30.3 ","code_information":[{"code":"138","type":"RC"},{"code":"B0403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32586.34,"maximum":37731.55,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36016.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36359.50,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32586.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":34301.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37731.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":34301.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36016.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32586.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33272.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34301.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":34301.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34301.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33615.38,"methodology":"fee schedule"}]}]},{"description":"Twin zygosity, genomic targeted sequence analysis of cromosome 2, using circulating cell-free fetal DNA in maternal blood ","code_information":[{"code":"0060U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":759.05,"maximum":1594.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":804.59,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":804.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":865.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":910.86,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1594.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":872.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":762.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1594.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":797.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1594.00,"methodology":"fee schedule"}]}]},{"description":"Vantas implant ","code_information":[{"code":"1711","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1567.97,"maximum":3292.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1724.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1677.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1662.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1662.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1599.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1599.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1787.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1724.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1677.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1724.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1677.73,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1599.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1881.56,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3292.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1803.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1575.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3292.74,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1646.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1567.97,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3292.74,"methodology":"fee schedule"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC ","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":119663.72,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23478.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24169.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24399.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":23709.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":31945.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":42978.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":31945.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23248.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23248.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":48441.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":75076.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":48441.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":31945.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24399.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25320.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":119663.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":49543.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":119663.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23709.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23478.95,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":40150.11,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":42157.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24169.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":23939.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24629.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22328.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24169.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":24399.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":44886.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28773.23,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":24169.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23363.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23478.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":52954.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22028.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23018.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":44886.23,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":23018.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":23018.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23363.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22558.21,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":44886.23,"methodology":"fee schedule"}]}]},{"description":"Alpha-fetoprotein (AFP); serum ","code_information":[{"code":"82105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.20,"maximum":35.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":35.22,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 36.25 & M < 47.65 ","code_information":[{"code":"148","type":"RC"},{"code":"D1002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19349.13,"maximum":22404.26,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21385.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21589.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19349.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20367.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22404.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20367.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21385.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19349.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19756.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20367.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20367.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20367.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19960.16,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M > 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"B1101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21118.77,"maximum":24453.31,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23341.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23564.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21118.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22230.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24453.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22230.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23341.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21118.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21563.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22230.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22230.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22230.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21785.68,"methodology":"fee schedule"}]}]},{"description":"Antibody; hepatitis, delta agent ","code_information":[{"code":"86692","type":"CPT"},{"code":"L000303402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.55,"maximum":36.04,"gross_charge":73.65,"discounted_cash":73.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.36,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.59,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":36.04,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":36.04,"methodology":"fee schedule"}]}]},{"description":"Artiss fibrin sealant ","code_information":[{"code":"1848","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":138.35,"maximum":290.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":152.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":148.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":146.65,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":146.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":157.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":152.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":148.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":152.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":148.03,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":166.02,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":290.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":159.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":139.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":290.53,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":145.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":290.53,"methodology":"fee schedule"}]}]},{"description":"Basiliximab ","code_information":[{"code":"1683","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4588.77,"maximum":9636.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5047.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4909.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4864.10,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4864.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4680.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4680.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5231.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5047.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4909.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5047.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4909.98,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4680.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5506.52,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9636.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5277.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4611.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9636.42,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4818.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9636.42,"methodology":"fee schedule"}]}]},{"description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health ca ","code_information":[{"code":"90913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.62,"maximum":66.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.87,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":66.28,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":66.28,"methodology":"fee schedule"}]}]},{"description":"BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) ","code_information":[{"code":"81166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":301.35,"maximum":632.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":331.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":322.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":319.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":319.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":307.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":307.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":343.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":331.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":322.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":331.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":322.44,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":307.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":361.62,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":632.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":346.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":302.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":632.84,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":316.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":632.84,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"148","type":"RC"},{"code":"D2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29401.00,"maximum":34043.26,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32495.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32805.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29401.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34043.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32495.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29401.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30019.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30329.45,"methodology":"fee schedule"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETER ","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":112078.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":65400.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":112078.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":91338.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":67323.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":67964.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":124680.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":58268.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":114482.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":66041.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":67869.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":91310.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":67869.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":64758.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":64758.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":102916.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":159503.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":102916.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":67869.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":67964.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70529.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":66041.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":65400.06,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":113733.90,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":119420.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":67323.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":66682.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":68605.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":62194.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":67323.60,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":67964.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":125029.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":80147.14,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":67323.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":65079.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":65400.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":147039.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":61360.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64117.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":125029.53,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":64117.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":64117.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":65079.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":62835.36,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":125029.53,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 38.55 & M < 48.85 ","code_information":[{"code":"158","type":"RC"},{"code":"C1402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18823.25,"maximum":21795.34,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20804.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21002.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18823.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19813.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21795.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19813.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20804.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18823.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19219.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19813.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19813.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19813.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19417.67,"methodology":"fee schedule"}]}]},{"description":" Emergency Room Urgent Care  ","code_information":[{"code":"456","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":180.00,"maximum":4344.00,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":739.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":1541.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":2039.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":1541.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":1421.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":4344.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":1421.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":1541.00,"methodology":"case rate"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":845.00,"methodology":"case rate"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":825.00,"methodology":"case rate"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":2426.00,"methodology":"case rate"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":745.00,"methodology":"case rate"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":745.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":2426.00,"methodology":"case rate"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":850.00,"methodology":"case rate"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":800.00,"methodology":"case rate"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":700.00,"methodology":"case rate"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":180.00,"methodology":"case rate"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"case rate"}]}]},{"description":"Alteplase recombinant ","code_information":[{"code":"7048","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":91.47,"maximum":192.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":100.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":97.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":96.96,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":96.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":93.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":93.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":104.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":100.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":97.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":100.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":97.87,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":93.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":109.76,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":192.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":105.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":91.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":192.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":96.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":91.47,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":192.09,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M < 36.25 ","code_information":[{"code":"128","type":"RC"},{"code":"D1003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22669.70,"maximum":26249.13,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25055.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25294.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22669.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23862.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26249.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23862.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25055.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22669.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23146.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23862.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23862.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23862.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23385.59,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M > 36.35 ","code_information":[{"code":"138","type":"RC"},{"code":"C1101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16976.82,"maximum":19657.37,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18763.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18942.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16976.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19657.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18763.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16976.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17334.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17870.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17512.93,"methodology":"fee schedule"}]}]},{"description":"Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) ","code_information":[{"code":"86664","type":"CPT"},{"code":"L000296502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.86,"maximum":32.11,"gross_charge":125.25,"discounted_cash":125.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":32.11,"methodology":"fee schedule"}]}]},{"description":"APPENDIX PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49249.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10019.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10313.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10412.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":10117.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11917.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16034.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11917.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9920.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9920.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18072.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":28008.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18072.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11917.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10412.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10805.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49249.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20390.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49249.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10117.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10019.18,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16524.27,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":17350.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10313.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10215.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10510.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9528.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10313.86,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10412.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":19154.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12278.41,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10313.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9970.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10019.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9400.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9822.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":19154.31,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":9822.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":9822.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9970.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9626.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":19154.31,"methodology":"fee schedule"}]}]},{"description":"Argatroban dialysis (acco ","code_information":[{"code":"9021","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.20,"maximum":8.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":8.82,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test ","code_information":[{"code":"86902","type":"CPT"},{"code":"L000327901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.35,"maximum":13.33,"gross_charge":124.25,"discounted_cash":124.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":13.33,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"158","type":"RC"},{"code":"C2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29401.00,"maximum":34043.26,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32495.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32805.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":29401.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34043.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32495.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29401.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30019.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30948.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30329.45,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M < 31.15 ","code_information":[{"code":"158","type":"RC"},{"code":"A1404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24143.84,"maximum":27956.03,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26685.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26939.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24143.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27956.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26685.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24143.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24652.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25414.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24906.28,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 48.85 ","code_information":[{"code":"158","type":"RC"},{"code":"A1401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12697.97,"maximum":14702.91,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14034.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14168.26,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12697.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14702.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14034.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12697.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12965.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13366.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13098.96,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITH MCC ","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47104.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14137.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":15492.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14552.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14691.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":21630.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":12172.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":19860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14275.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26971.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13998.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13998.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28778.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27216.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28778.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20172.00,"methodology":"case rate"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14691.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15245.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47104.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19502.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47104.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14275.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14137.01,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11908.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":12503.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14552.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14414.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14830.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13444.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14552.80,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":11580.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14691.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":27026.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17324.76,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14552.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14067.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14137.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13263.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13859.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":27026.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13859.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13859.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14067.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13582.61,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":27026.63,"methodology":"fee schedule"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC ","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":85832.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17012.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17512.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17679.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":17178.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12489.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16803.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12489.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16845.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16845.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18939.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":29352.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18939.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12489.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17679.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18346.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":85832.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":35536.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":85832.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17178.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17012.03,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28798.77,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":30238.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17512.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17345.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17845.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16178.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17512.38,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17679.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":32523.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20848.07,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17512.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16928.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17012.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15961.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16678.46,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":32523.00,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":16678.46,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":16678.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16928.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16344.89,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":32523.00,"methodology":"fee schedule"}]}]},{"description":"Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient ger ","code_information":[{"code":"81265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233.07,"maximum":489.45,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":256.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":249.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":247.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":237.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":237.73,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":265.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":256.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":249.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":256.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":249.38,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":237.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":279.68,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":489.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":268.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":234.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":489.45,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":244.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":489.45,"methodology":"fee schedule"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC ","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":67711.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13548.26,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13946.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14079.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13681.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8100.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10898.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8100.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13415.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13415.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12284.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19038.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12284.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8100.92,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14079.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14610.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":67711.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28033.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":67711.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13681.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13548.26,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22718.85,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":23854.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13946.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13813.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14212.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12884.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13946.74,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14079.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25901.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16603.26,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13946.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13481.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13548.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12711.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13282.61,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25901.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13282.61,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13282.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13481.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13016.96,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25901.09,"methodology":"fee schedule"}]}]},{"description":"CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, 5? gene duplication/multiplication) (List separately in addition to ","code_information":[{"code":"0075U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.91,"maximum":946.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":514.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":541.09,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":518.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":453.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":473.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"}]}]},{"description":"Dental Procedures ","code_information":[{"code":"5871","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":810.51,"maximum":1702.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":891.56,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":867.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":859.14,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":859.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":826.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":826.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":923.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":891.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":867.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":891.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":867.25,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":826.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":972.61,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1702.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":932.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":814.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1702.07,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":851.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":810.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1702.07,"methodology":"fee schedule"}]}]},{"description":"Echo guidance radiotherap ","code_information":[{"code":"4001","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":137.27,"maximum":288.27,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":151.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.51,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":145.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":140.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":140.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":156.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":151.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":151.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.88,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":140.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.73,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":288.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":288.27,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":144.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":288.27,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, NOT ORTHOPEDIC, LENGTH OF STAY IS 16 DAYS ","code_information":[{"code":"128","type":"RC"},{"code":"A5104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":39790.10,"maximum":46072.74,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43978.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":44397.37,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":39790.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41884.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":46072.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":41884.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43978.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":39790.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40627.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41884.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":41884.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":41884.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":41046.62,"methodology":"fee schedule"}]}]},{"description":"Flebogamma injection ","code_information":[{"code":"947","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":56.12,"maximum":117.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":61.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":60.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":59.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":63.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":61.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":60.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":61.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":60.04,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":57.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":67.34,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":117.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":64.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":56.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":117.84,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":58.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":56.12,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":117.84,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"118","type":"RC"},{"code":"D0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23305.77,"maximum":26985.63,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25759.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26004.33,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23305.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26985.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25759.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23305.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23796.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24532.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24041.74,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"148","type":"RC"},{"code":"C0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16197.18,"maximum":18754.63,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17902.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18072.64,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16197.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17049.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18754.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17049.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17902.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16197.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16538.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17049.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17049.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17049.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16708.67,"methodology":"fee schedule"}]}]},{"description":"Gastric acid analysis, includes pH if performed, each specimen ","code_information":[{"code":"82930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.08,"maximum":14.09,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":14.09,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M < 18.05 ","code_information":[{"code":"148","type":"RC"},{"code":"B1903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":41927.01,"maximum":48547.07,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46340.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46781.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":41927.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":44133.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":48547.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":44133.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46340.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":41927.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42809.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":44133.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":44133.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44133.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43251.02,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori; drug administration ","code_information":[{"code":"83014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.12,"maximum":16.51,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":16.51,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C antibody; ","code_information":[{"code":"86803","type":"CPT"},{"code":"L000322002","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.93,"maximum":29.97,"gross_charge":118.00,"discounted_cash":118.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":29.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":29.97,"methodology":"fee schedule"}]}]},{"description":"Human epididymis protein 4 (HE4) ","code_information":[{"code":"86305","type":"CPT"},{"code":"L000252701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":18.86,"maximum":43.70,"gross_charge":89.30,"discounted_cash":89.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":43.70,"methodology":"fee schedule"}]}]},{"description":"Imiglucerase injection ","code_information":[{"code":"1327","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":43.62,"maximum":91.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":47.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":49.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":91.59,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":45.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":91.59,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA), Bartonella henselae and Bartonella quintana, droplet digital PCR (ddPCR); following liquid enrichment ","code_information":[{"code":"0302U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":361.37,"maximum":758.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":397.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":386.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":383.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":383.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":368.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":368.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":411.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":397.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":386.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":397.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":386.67,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":368.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":433.64,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":758.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":415.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":363.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":758.88,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":379.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":758.88,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, direct probe technique ","code_information":[{"code":"87525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.01,"maximum":62.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":62.58,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":62.58,"methodology":"fee schedule"}]}]},{"description":"Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions ","code_information":[{"code":"87901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233.34,"maximum":540.64,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":283.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":275.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":272.90,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":272.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":293.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":283.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":275.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":283.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":275.47,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":233.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":308.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":540.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":296.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":258.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":540.64,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":270.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":540.64,"methodology":"fee schedule"}]}]},{"description":"Inj golodirsen 10 mg ","code_information":[{"code":"9356","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":166.22,"maximum":349.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":182.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":177.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":176.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":176.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":189.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":182.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":177.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":182.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":177.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":199.47,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":349.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":167.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":349.07,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":174.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":349.07,"methodology":"fee schedule"}]}]},{"description":"Inj tofersen intrathec 1 ","code_information":[{"code":"9262","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":153.66,"maximum":322.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":169.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":164.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":162.88,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":162.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":156.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":156.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":175.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":169.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":164.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":169.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":164.42,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":156.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":184.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":322.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":176.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":154.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":322.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":161.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":153.66,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":322.69,"methodology":"fee schedule"}]}]},{"description":"Inj, cyclophosphamd, sand ","code_information":[{"code":"785","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.34,"maximum":9.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.34,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":9.11,"methodology":"fee schedule"}]}]},{"description":"Inj, sculptra, 0.5mg ","code_information":[{"code":"9095","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.40,"maximum":2.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.50,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2.94,"methodology":"fee schedule"}]}]},{"description":"Inj., brexanolone, 1 mg ","code_information":[{"code":"9333","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":72.00,"maximum":151.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":77.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":76.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":73.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":73.44,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":82.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":77.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":77.04,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":73.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":86.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":151.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":82.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":72.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":151.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":75.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":72.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":151.20,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS ","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":63342.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":27365.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9122.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":27365.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22301.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9390.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9479.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":29603.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":9211.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14072.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18932.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14072.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9032.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9032.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":21338.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":33071.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21338.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14072.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9479.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9837.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48710.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20167.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48710.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9211.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9122.25,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14949.90,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":15697.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9390.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":9301.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9569.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8675.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9390.55,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9479.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":17439.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11179.23,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9390.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9077.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9122.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8558.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8943.38,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":17439.60,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":8943.38,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":8943.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9077.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8764.52,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":17439.60,"methodology":"fee schedule"}]}]},{"description":"Leukocyte phagocytosis ","code_information":[{"code":"86344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.42,"maximum":21.82,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.60,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.12,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":10.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21.82,"methodology":"fee schedule"}]}]},{"description":"Level 2 Endovascular Proc ","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5261.55,"maximum":11049.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5787.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5629.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5577.25,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":5577.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5366.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5366.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":5998.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5787.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5629.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5787.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5629.86,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":5366.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6313.86,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":11049.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6050.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5287.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":11049.26,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5524.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5261.55,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":11049.26,"methodology":"fee schedule"}]}]},{"description":"Level 4 Airway Endoscopy ","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3447.31,"maximum":7239.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3792.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3688.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3654.15,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3654.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3516.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3516.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3929.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3792.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3688.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3792.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3688.62,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3516.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4136.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":7239.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3964.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3464.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":7239.34,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3619.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":7239.34,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) ","code_information":[{"code":"83701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.69,"maximum":71.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":71.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":71.11,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":71.11,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"118","type":"RC"},{"code":"B1703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32955.29,"maximum":38158.76,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36424.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36771.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":32955.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":34689.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38158.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":34689.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36424.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32955.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33649.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34689.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":34689.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34689.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33995.99,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"138","type":"RC"},{"code":"A1801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":12429.19,"maximum":14391.69,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13737.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13868.36,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12429.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13083.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14391.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13083.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13737.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12429.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12690.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13083.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13083.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13083.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12821.69,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"158","type":"RC"},{"code":"D1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23108.77,"maximum":26757.53,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25541.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25784.53,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23108.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26757.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25541.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23108.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23595.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24325.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23838.52,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC ","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75742.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15083.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15526.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15674.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15231.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9173.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12342.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9173.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14935.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14935.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13911.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21559.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13911.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9173.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15674.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16266.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":75742.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31358.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75742.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15231.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15083.34,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25413.36,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":26684.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15526.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15379.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15822.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14343.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15526.97,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15674.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28835.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18484.49,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15526.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15009.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15083.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14151.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14787.59,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28835.80,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":14787.59,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":14787.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15009.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14491.84,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28835.80,"methodology":"fee schedule"}]}]},{"description":"MINOR BLADDER PROCEDURES WITH CC ","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":66914.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13395.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13789.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13921.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13527.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12299.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16547.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12299.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13264.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13264.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18650.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":28904.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18650.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12299.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13921.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14446.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":66914.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":27703.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":66914.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13527.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13395.84,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22451.31,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":23573.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13789.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13658.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14052.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12739.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13789.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13921.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25609.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16416.47,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13789.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13330.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13395.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12568.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13133.18,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25609.70,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13133.18,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13133.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13330.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12870.52,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25609.70,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 49.15 ","code_information":[{"code":"128","type":"RC"},{"code":"A2001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":13384.12,"maximum":15497.41,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14792.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14933.86,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13384.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14088.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15497.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14088.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14792.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13384.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13665.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14088.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14088.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14088.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13806.78,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or dup ","code_information":[{"code":"81403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.20,"maximum":388.92,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":211.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":388.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":388.92,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":388.92,"methodology":"fee schedule"}]}]},{"description":"NERVOUS SYSTEM NEOPLASMS WITH MCC ","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":65678.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13159.68,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13546.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13675.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":13288.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12122.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16309.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12122.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13030.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13030.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18382.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":28489.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18382.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12122.47,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13675.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14191.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":65678.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":27192.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":65678.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13288.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13159.68,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22036.77,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":23138.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13546.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13417.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13804.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12514.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13546.73,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13675.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25158.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16127.06,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13546.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13095.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13159.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12346.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12901.65,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25158.22,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12901.65,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12901.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13095.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12643.62,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25158.22,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"128","type":"RC"},{"code":"D0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15504.35,"maximum":17952.40,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17136.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17299.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15504.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17952.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17136.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15504.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15830.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16320.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15993.96,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 24 ","code_information":[{"code":"1561","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3140.50,"maximum":6595.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3454.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3328.93,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3328.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3203.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3203.31,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3580.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3454.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3454.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3203.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3768.60,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":6595.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3611.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3156.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":6595.06,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3297.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":6595.06,"methodology":"fee schedule"}]}]},{"description":"Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes ","code_information":[{"code":"98972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.52,"maximum":64.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32.66,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":64.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":64.09,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":64.09,"methodology":"fee schedule"}]}]},{"description":"Carmustine injection ","code_information":[{"code":"812","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":330.87,"maximum":694.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":363.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":354.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":350.72,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":350.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":337.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":337.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":377.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":363.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":354.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":363.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":354.03,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":337.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":397.05,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":694.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":380.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":332.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":694.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":347.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":330.87,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":694.83,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC ","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":55667.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11246.07,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11576.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11687.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":7220.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":11356.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4586.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":6171.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4586.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11135.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11135.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6955.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10779.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6955.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4586.88,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":11687.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12128.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":55667.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23047.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":55667.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11356.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11246.07,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18677.82,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":19611.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11576.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":11466.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11797.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10694.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11576.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11687.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":21499.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13781.95,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11576.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11190.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11246.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10236.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10551.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11025.56,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":21499.84,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":11025.56,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":11025.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11190.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10805.05,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":21499.84,"methodology":"fee schedule"}]}]},{"description":"Complement; functional activity, each component ","code_information":[{"code":"86161","type":"CPT"},{"code":"L000229602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.87,"maximum":25.20,"gross_charge":51.50,"discounted_cash":51.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":25.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":25.20,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":25.20,"methodology":"fee schedule"}]}]},{"description":"Creatine kinase (CK), (CPK); isoenzymes ","code_information":[{"code":"82552","type":"CPT"},{"code":"L000104702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.13,"maximum":28.12,"gross_charge":4.55,"discounted_cash":4.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.12,"methodology":"fee schedule"}]}]},{"description":"CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN) ","code_information":[{"code":"81226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.91,"maximum":946.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":514.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":541.09,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":518.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":453.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":473.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":946.91,"methodology":"fee schedule"}]}]},{"description":"Drug Assay, presumptive, 30 or more drugs or metabolites, urine, liquid chromatography with tandem mass spectrometry using multiple reaction monitoring w drug or metabolite description, incl simple va ","code_information":[{"code":"0227U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62.14,"maximum":130.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":70.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":74.57,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":130.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":71.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":62.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":130.49,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":130.49,"methodology":"fee schedule"}]}]},{"description":"Everolimus ","code_information":[{"code":"80169","type":"CPT"},{"code":"L000003302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.45,"maximum":28.83,"gross_charge":58.90,"discounted_cash":58.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.48,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.83,"methodology":"fee schedule"}]}]},{"description":"Ferritin ","code_information":[{"code":"82728","type":"CPT"},{"code":"L000114101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.36,"maximum":28.62,"gross_charge":829.55,"discounted_cash":829.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":28.62,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":28.62,"methodology":"fee schedule"}]}]},{"description":"Fluocinolone acetonide im ","code_information":[{"code":"9225","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":333.48,"maximum":700.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":366.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":353.49,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":353.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":340.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":340.15,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":380.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":366.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":366.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":340.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":400.18,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":700.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":383.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":335.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":700.31,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":350.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":700.31,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 34.15 & M < 42.15 ","code_information":[{"code":"158","type":"RC"},{"code":"C0702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20006.90,"maximum":23165.89,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22112.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22323.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20006.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21059.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23165.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21059.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22112.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20006.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20428.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21059.90,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21059.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21059.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20638.70,"methodology":"fee schedule"}]}]},{"description":"Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry ","code_information":[{"code":"82805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71.39,"maximum":165.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":86.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":83.50,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":83.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":80.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":80.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":89.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":86.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":86.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":84.28,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":80.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":71.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":165.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":90.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":165.42,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":82.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":78.77,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":165.42,"methodology":"fee schedule"}]}]},{"description":"Goserelin acetate implant ","code_information":[{"code":"810","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":674.77,"maximum":1417.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":742.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":722.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":715.26,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":715.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":688.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":688.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":769.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":742.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":722.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":742.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":722.01,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":688.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":809.73,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1417.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":775.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":678.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1417.02,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":708.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":674.77,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1417.02,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 18.05 & M < 35.95 ","code_information":[{"code":"148","type":"RC"},{"code":"C1902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21364.18,"maximum":24737.47,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23613.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23837.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21364.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22488.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24737.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22488.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23613.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21364.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21813.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22488.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22488.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22488.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22038.84,"methodology":"fee schedule"}]}]},{"description":"Hematology (von Willebrand disease [VWD]), von Willebrand propeptide, enzyme-linked immunosorbent assays (ELISA), plasma, diagnostic report of von Willebrand factor (VWF) propeptide antigen level ","code_information":[{"code":"0281U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.27,"maximum":36.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":36.27,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":36.27,"methodology":"fee schedule"}]}]},{"description":"Hereditary colon cancer (Lynch syndrome), targeted mRNA sequence analysis panel (MLH1, MSH2, MSH6, PMS2) (List separately in addition to code for primary procedure) ","code_information":[{"code":"0162U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":486.54,"maximum":1021.73,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":535.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":520.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":515.73,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":515.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":496.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":496.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":554.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":535.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":520.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":535.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":520.60,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":496.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":583.85,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1021.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":559.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":488.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1021.73,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":510.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":486.54,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1021.73,"methodology":"fee schedule"}]}]},{"description":"Homocysteine ","code_information":[{"code":"83090","type":"CPT"},{"code":"L000125602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.24,"maximum":37.63,"gross_charge":137.85,"discounted_cash":137.85,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.50,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":37.63,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.60,"maximum":31.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":31.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":31.50,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":31.50,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique ","code_information":[{"code":"87486","type":"CPT"},{"code":"L000365202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":73.69,"gross_charge":150.60,"discounted_cash":150.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":40.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":73.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":73.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":73.69,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Zika virus, amplified probe technique ","code_information":[{"code":"87662","type":"CPT"},{"code":"L000373502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":46.50,"maximum":107.75,"gross_charge":450.30,"discounted_cash":450.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":46.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.57,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":107.75,"methodology":"fee schedule"}]}]},{"description":"Inj glofitamab gxbm, 2.5 ","code_information":[{"code":"720","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2701.04,"maximum":5672.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2971.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2890.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2863.10,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":2863.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2755.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2755.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3079.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2971.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2890.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2971.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2890.11,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":2755.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3241.25,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":5672.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3106.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2714.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":5672.18,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2836.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2701.04,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":5672.18,"methodology":"fee schedule"}]}]},{"description":"Inj sebelipase alfa 1 mg ","code_information":[{"code":"9478","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":539.42,"maximum":1132.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":593.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":577.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":571.79,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":571.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":550.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":550.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":614.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":593.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":577.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":593.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":577.18,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":550.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":647.31,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1132.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":542.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1132.78,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":566.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":539.42,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1132.78,"methodology":"fee schedule"}]}]},{"description":"Inj, carmustine (accord) ","code_information":[{"code":"718","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":259.70,"maximum":545.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":275.28,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":275.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":264.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":264.89,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":296.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":264.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":311.64,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":545.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":298.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":261.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":545.37,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":272.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":545.37,"methodology":"fee schedule"}]}]},{"description":"Inj, tarlatamab-dlle, 1 m ","code_information":[{"code":"768","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1545.00,"maximum":3244.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1699.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1653.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1637.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1637.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1575.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1575.90,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1761.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1699.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1653.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1699.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1653.15,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1575.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1854.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3244.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1776.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1552.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3244.50,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1622.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1545.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3244.50,"methodology":"fee schedule"}]}]},{"description":"Inj., emapalumab-lzsg, 1 ","code_information":[{"code":"9310","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":378.03,"maximum":793.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":415.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":404.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":400.71,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":400.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":385.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":385.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":430.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":415.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":404.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":415.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":404.49,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":385.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":453.63,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":793.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":434.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":379.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":793.86,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":396.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":793.86,"methodology":"fee schedule"}]}]},{"description":"Injection, khapzory, 0.5 ","code_information":[{"code":"9334","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.38,"maximum":2.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":2.89,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC ","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":113218.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22247.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22901.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23119.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":22465.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21758.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29273.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21758.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22028.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22028.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":32994.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":51136.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":32994.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21758.77,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23119.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23991.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":113218.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":46874.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":113218.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22465.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22247.05,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":37987.74,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":39887.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22901.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":22683.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23337.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21156.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22901.37,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":23119.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42531.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27263.54,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":22901.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22137.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22247.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":66006.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20872.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21810.83,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42531.12,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":21810.83,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":21810.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22137.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21374.61,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42531.12,"methodology":"fee schedule"}]}]},{"description":"Lactogen, human placental (HPL) human chorionic somatomammotropin ","code_information":[{"code":"83632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.32,"maximum":42.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":23.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":42.46,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":42.46,"methodology":"fee schedule"}]}]},{"description":"Level 2 Musculoskeletal P ","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1479.51,"maximum":3106.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1627.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1583.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1568.28,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":1568.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1509.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1509.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1686.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1627.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1583.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1627.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1583.08,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":1509.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1775.41,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":3106.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1701.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1486.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":3106.97,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1553.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1479.51,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":3106.97,"methodology":"fee schedule"}]}]},{"description":"Lipase ","code_information":[{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.25,"maximum":14.47,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":14.47,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":14.47,"methodology":"fee schedule"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":91006.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18001.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18530.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18707.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9387.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":18177.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":35822.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":48194.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":35822.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17824.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17824.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":54320.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":84187.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":54320.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":35822.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18707.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19412.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":91006.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37678.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":91006.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18177.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18001.08,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":30534.84,"methodology":"fee schedule"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":32061.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18530.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":18354.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18883.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17118.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18530.53,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18707.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":34413.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22060.15,"methodology":"fee schedule"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","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","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18530.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17912.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18001.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12756.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $453797.00, reimbursement will be $5216 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16889.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17648.12,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":34413.83,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":17648.12,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":17648.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17912.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17295.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":34413.83,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"128","type":"RC"},{"code":"B1701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22322.45,"maximum":25847.05,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24672.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24907.16,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22322.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23497.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25847.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23497.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24672.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22322.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22792.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23497.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23497.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23497.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23027.37,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"138","type":"RC"},{"code":"B1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30511.19,"maximum":35328.75,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33722.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34044.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":30511.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32117.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35328.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32117.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33722.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30511.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31153.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32117.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32117.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32117.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31474.70,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) full gene analysis, including small sequence changes in exonic and intronic regions, deletions, duplications, mobile element insertions, and variants in non-unique ","code_information":[{"code":"0234U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527.87,"maximum":1108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":580.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":559.54,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":559.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":538.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":538.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":601.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":580.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":580.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":538.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":633.44,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1108.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":607.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":530.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1108.53,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":554.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1108.53,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 49.15 ","code_information":[{"code":"118","type":"RC"},{"code":"C2001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15741.41,"maximum":18226.90,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17398.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17564.10,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15741.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18226.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17398.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15741.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16072.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16569.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16238.51,"methodology":"fee schedule"}]}]},{"description":"Monovisc inj per dose ","code_information":[{"code":"1747","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":683.16,"maximum":1434.65,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":751.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":730.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":724.15,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":724.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":696.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":696.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":778.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":751.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":730.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":751.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":730.99,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":696.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":819.80,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1434.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":785.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":686.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1434.65,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":717.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":683.16,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1434.65,"methodology":"fee schedule"}]}]},{"description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing ","code_information":[{"code":"97606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49.25,"maximum":103.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":52.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":56.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":52.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":52.70,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":59.10,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":103.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":56.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":49.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":103.43,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":51.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":103.43,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"148","type":"RC"},{"code":"B0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22182.22,"maximum":25684.67,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24517.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24750.69,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22182.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23349.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25684.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23349.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24517.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22182.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22649.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23349.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23349.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23349.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22882.71,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 25 ","code_information":[{"code":"1525","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3623.58,"maximum":7609.52,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3985.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3877.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3841.00,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":3841.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3696.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3696.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4130.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3985.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3877.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3985.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3877.23,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":3696.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4348.30,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":7609.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4167.12,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3641.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":7609.52,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3804.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3623.58,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":7609.52,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 46 ","code_information":[{"code":"1583","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":72462.48,"maximum":152171.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":79708.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":77534.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":76810.23,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":76810.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":73911.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":73911.73,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":82607.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":79708.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":77534.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":79708.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":77534.85,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":73911.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":86954.98,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":152171.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":83331.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":72824.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":152171.21,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":76085.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":152171.21,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M < 26.15 ","code_information":[{"code":"148","type":"RC"},{"code":"C0304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28878.45,"maximum":33438.21,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31918.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32222.27,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":28878.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30398.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33438.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":30398.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31918.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28878.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29486.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30398.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30398.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30398.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29790.40,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"128","type":"RC"},{"code":"B0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20011.91,"maximum":23171.69,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22118.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22329.08,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":20011.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21065.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23171.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21065.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22118.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20011.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20433.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21065.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21065.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21065.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20643.87,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 40.15 & M < 5 ","code_information":[{"code":"158","type":"RC"},{"code":"A0502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18011.89,"maximum":20855.87,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19907.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20097.47,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18011.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20855.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19907.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18011.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18391.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18959.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18580.68,"methodology":"fee schedule"}]}]},{"description":"NUDT15 (nudix hydrolase 15) and TPMT (thiopurine S-methyltransferase) (eg, drug metabolism) gene analysis, common variants ","code_information":[{"code":"0169U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":466.17,"maximum":978.96,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":512.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":498.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":494.14,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":494.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":475.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":475.49,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":531.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":512.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":498.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":512.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":498.80,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":475.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":559.40,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":978.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":536.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":468.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":978.96,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":489.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":978.96,"methodology":"fee schedule"}]}]},{"description":"Oncology (gastrointestinal neuroendocrine tumors), real-time PCR expression analysis of 51 genes, utilizing whole peripheral blood, algorithm reported as a nomogram of tumor disease index ","code_information":[{"code":"0007M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":375.00,"maximum":787.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":412.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":397.50,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MGMCR","standard_charge_dollar":397.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":382.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":382.50,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":427.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":412.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":412.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":401.25,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":382.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":450.00,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":787.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":431.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":376.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":787.50,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":393.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":375.00,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":787.50,"methodology":"fee schedule"}]}]},{"description":"Level 1 Type A ED Visits ","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":81.73,"maximum":171.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":89.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":89.90,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":109.51,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":171.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":171.63,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":171.63,"methodology":"fee schedule"}]}]},{"description":"Level 5 Type A ED Visits ","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":591.28,"maximum":1241.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":650.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":650.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":591.28,"methodology":"fee schedule"},{"payer_name":"Freedom Optimum","plan_name":"MCR","standard_charge_dollar":792.32,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"PRISN","standard_charge_dollar":1241.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":591.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":591.28,"methodology":"fee schedule"},{"payer_name":"University MA Federal Corrections ","plan_name":"GVT","standard_charge_dollar":1241.69,"methodology":"fee schedule"},{"payer_name":"VA Purchased Care Program","plan_name":"LOGOV","standard_charge_dollar":591.28,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services ","plan_name":"MCR","standard_charge_dollar":591.28,"methodology":"fee schedule"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_dollar":1241.69,"methodology":"fee schedule"}]}]},{"description":" Operating Room Services Minor Surgery  ","code_information":[{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2503.00,"maximum":10303.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":3071.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":3071.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2503.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4889.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":22.30,"standard_charge_algorithm":"Reimbursement will be 22.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":15.00,"standard_charge_algorithm":"Reimbursement will be 15% of billable gross charges.","estimated_amount":5470.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_dollar":3925.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":10303.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":10303.00,"methodology":"case rate"},{"payer_name":"Integrated Health Plan ","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":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":3183.00,"methodology":"case rate"}]}]},{"description":"CATH BLNDIL 4X20X135 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120437","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 4X30X135 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120438","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5.5X20X135 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120460","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 12MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000316789","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1039.00,"discounted_cash":1039.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":180.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":180.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":157.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":290.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":135.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":259.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":114.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":153.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":114.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":176.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":268.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":176.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":114.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":457.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":189.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":457.16,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":238.97,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":238.97,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":207.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":207.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":332.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":197.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":810.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":935.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":519.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":883.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":883.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":883.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":519.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":519.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":166.24,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1090.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":285.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":467.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":198.45,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 15MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000875742","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1455.00,"discounted_cash":1455.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":253.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":253.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":221.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":407.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":189.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":363.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":215.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":247.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":375.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":247.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":640.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":264.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":640.20,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":334.65,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":334.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":465.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":276.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1134.90,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1309.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":727.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1236.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1236.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1236.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":727.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":727.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":232.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1527.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":400.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":654.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":277.91,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 200MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000264212","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1205.00,"discounted_cash":1205.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":209.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":209.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":183.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":337.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":156.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":301.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":132.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":178.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":132.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":204.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":310.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":204.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":132.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":530.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":219.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":530.20,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":277.15,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":277.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":241.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":241.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":385.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":228.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":939.90,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1084.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":602.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1024.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1024.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1024.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":602.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":602.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":192.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1265.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":331.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":542.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":230.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952364","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952365","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2154.00,"discounted_cash":2154.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":374.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":374.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":327.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":603.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":280.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":538.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":318.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":366.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":555.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":366.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":947.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":392.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":947.76,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":495.42,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":495.42,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":430.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":430.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":689.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":409.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1680.12,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1938.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1077.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1830.90,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1830.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1830.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1077.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1077.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":344.64,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2261.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":592.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":969.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":411.41,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 40MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000731948","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2216.00,"discounted_cash":2216.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":336.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":620.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":288.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":554.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":327.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":376.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":571.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":376.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":975.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":403.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":975.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":509.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":509.68,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":709.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":421.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1728.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1994.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":354.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2326.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":609.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":997.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":423.26,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5MM 80MM ","code_information":[{"code":"C2623","type":"HCPCS"},{"code":"S000509973","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17312.00,"discounted_cash":17312.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3012.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3012.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2631.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4847.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2250.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4328.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1904.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2562.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1904.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2943.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4466.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2943.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1904.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7617.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3150.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7617.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3981.76,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3981.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3462.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3462.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5539.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3289.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":13503.36,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15580.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8656.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14715.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14715.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14715.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8656.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8656.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2769.92,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":18177.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4760.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7790.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3306.59,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5X120MM ","code_information":[{"code":"C2623","type":"HCPCS"},{"code":"S007376191","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17173.00,"discounted_cash":17173.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2988.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2988.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2610.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4808.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2232.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4293.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1889.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2541.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1889.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2919.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4430.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2919.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1889.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7556.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3125.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7556.12,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3949.79,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3949.79,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3434.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3434.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5495.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3262.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":13394.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15455.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8586.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14597.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14597.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14597.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8586.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8586.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2747.68,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":18031.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4722.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7727.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3280.04,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5X2 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000155857","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":836.00,"discounted_cash":836.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":145.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":145.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":127.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":234.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":108.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":209.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":123.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":215.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":367.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":152.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":367.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":192.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":192.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":167.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":167.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":267.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":158.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":652.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":752.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":133.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":877.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":229.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":376.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":159.68,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 5X30X135 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120454","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 6MM 150MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000003212","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2216.00,"discounted_cash":2216.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":336.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":620.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":288.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":554.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":327.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":376.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":571.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":376.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":975.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":403.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":975.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":509.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":509.68,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":709.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":421.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1728.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1994.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":354.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2326.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":609.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":997.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":423.26,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 6MM 40MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000145934","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1095.00,"discounted_cash":1095.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":166.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":306.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":142.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":273.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":162.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":282.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":199.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":350.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":208.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":854.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":985.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":175.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1149.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":301.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":492.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":209.15,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 6MM 40MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000731967","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2216.00,"discounted_cash":2216.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":336.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":620.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":288.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":554.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":327.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":376.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":571.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":376.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":975.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":403.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":975.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":509.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":509.68,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":709.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":421.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1728.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1994.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1883.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1108.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":354.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2326.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":609.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":997.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":423.26,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 6MM 40MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952399","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 6X40X 135 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120470","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 75CM 7X60MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000215415","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2286.00,"discounted_cash":2286.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":397.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":397.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":347.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":640.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":297.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":571.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":251.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":338.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":251.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":388.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":589.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":388.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":251.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1005.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":416.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1005.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":525.78,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":525.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":457.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":457.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":731.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":434.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1783.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2057.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1143.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1943.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1943.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1943.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1143.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1143.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":365.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2400.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":628.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1028.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":436.63,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 7MM 100MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952433","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 7MM 20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952418","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 7X2 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000155865","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":836.00,"discounted_cash":836.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":145.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":145.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":127.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":234.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":108.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":209.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":123.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":215.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":367.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":152.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":367.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":192.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":192.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":167.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":167.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":267.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":158.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":652.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":752.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":133.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":877.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":229.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":376.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":159.68,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 7X20MM 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000735981","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9626.00,"discounted_cash":9626.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1674.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1674.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1463.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2695.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1251.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2406.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1058.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1424.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1058.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1636.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2483.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1636.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1058.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4235.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1751.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4235.44,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2213.98,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2213.98,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1925.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1925.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3080.32,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1828.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7508.28,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8663.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4813.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8182.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8182.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8182.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4813.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4813.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1540.16,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10107.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2647.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4331.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1838.57,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 7X20X80 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120488","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 8MM 20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000264408","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1095.00,"discounted_cash":1095.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":166.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":306.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":142.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":273.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":162.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":282.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":199.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":350.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":208.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":854.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":985.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":175.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1149.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":301.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":492.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":209.15,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 8MM 60MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952453","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 8MM 80MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952456","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 8X2 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000155868","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":836.00,"discounted_cash":836.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":145.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":145.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":127.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":234.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":108.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":209.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":123.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":215.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":367.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":152.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":367.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":192.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":192.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":167.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":167.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":267.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":158.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":652.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":752.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":710.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":418.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":133.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":877.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":229.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":376.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":159.68,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 9MM 100CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S002889061","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9199.00,"discounted_cash":9199.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1600.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1600.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1398.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2575.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1195.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2299.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1011.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1361.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1011.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1563.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2373.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1563.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1011.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4047.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1674.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4047.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2115.77,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2115.77,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1839.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1839.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2943.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1747.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7175.22,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8279.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4599.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7819.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7819.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7819.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4599.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4599.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1471.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":9658.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2529.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4139.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1757.01,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 9MM 20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000264457","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1095.00,"discounted_cash":1095.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":166.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":306.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":142.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":273.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":162.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":282.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":199.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":350.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":208.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":854.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":985.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":175.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1149.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":301.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":492.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":209.15,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 9MM 40MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000145952","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1095.00,"discounted_cash":1095.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":190.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":166.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":306.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":142.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":273.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":162.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":282.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":186.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":120.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":199.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":481.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":251.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":350.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":208.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":854.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":985.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":930.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":547.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":175.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1149.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":301.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":492.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":209.15,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL 9MM 80MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000952482","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1815.00,"discounted_cash":1815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":315.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":275.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":508.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":235.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":453.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":268.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":468.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":308.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":199.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":330.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":798.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":417.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":363.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":580.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":344.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1415.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1633.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1542.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":907.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":290.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1905.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":499.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":816.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":346.67,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDIL LG DIA 8 ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000517246","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3629.00,"discounted_cash":3629.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":631.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":631.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":551.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1016.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":471.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":907.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":399.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":537.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":399.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":616.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":936.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":616.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":399.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1596.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":660.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1596.76,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":834.67,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":834.67,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":725.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":725.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1161.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":689.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2830.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3266.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1814.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3084.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3084.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3084.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1814.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1814.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":580.64,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3810.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":997.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1633.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":693.14,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL 1.5MM 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001360939","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":15036.00,"discounted_cash":15036.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2285.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4210.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1954.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3759.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2225.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3879.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2736.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4811.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2856.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":11728.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13532.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2405.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":15787.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4134.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6766.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2871.88,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL 3.5MM 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001357321","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":15036.00,"discounted_cash":15036.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2285.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4210.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1954.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3759.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2225.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3879.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2736.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4811.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2856.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":11728.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13532.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2405.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":15787.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4134.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6766.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2871.88,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL 4MM 135CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001346667","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":15036.00,"discounted_cash":15036.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2285.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4210.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1954.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3759.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2225.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3879.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2736.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4811.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2856.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":11728.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13532.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2405.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":15787.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4134.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6766.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2871.88,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL 7X15MM 80CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000120487","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2147.00,"discounted_cash":2147.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":326.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":601.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":279.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":536.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":317.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":553.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":364.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":236.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":390.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":944.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":493.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":429.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":687.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":407.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1674.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1932.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1824.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1073.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":343.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2254.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":590.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":966.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":410.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL DCB 5X100X135 ","code_information":[{"code":"C2623","type":"HCPCS"},{"code":"S007376228","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":15788.00,"discounted_cash":15788.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2747.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2747.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2399.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4420.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2052.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3947.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1736.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2336.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1736.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2683.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4073.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2683.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1736.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6946.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2873.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6946.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3631.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3631.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3157.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3157.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5052.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2999.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":12314.64,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14209.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7894.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13419.80,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13419.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13419.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7894.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7894.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2526.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":16577.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4341.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7104.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3015.51,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL DCB 5X60X135 ","code_information":[{"code":"C2623","type":"HCPCS"},{"code":"S007376207","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":15788.00,"discounted_cash":15788.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2747.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2747.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2399.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4420.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2052.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3947.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1736.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2336.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1736.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2683.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4073.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2683.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1736.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6946.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2873.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6946.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3631.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3631.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3157.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3157.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5052.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2999.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":12314.64,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14209.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7894.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13419.80,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13419.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13419.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7894.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7894.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2526.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":16577.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4341.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7104.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3015.51,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNDL LG D 8FR 18MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000517229","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3629.00,"discounted_cash":3629.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":631.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":631.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":551.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1016.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":471.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":907.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":399.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":537.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":399.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":616.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":936.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":616.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":399.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1596.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":660.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1596.76,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":834.67,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":834.67,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":725.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":725.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1161.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":689.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2830.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3266.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1814.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3084.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3084.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3084.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1814.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1814.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":580.64,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3810.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":997.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1633.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":693.14,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNOCC 4MM 10MM ","code_information":[{"code":"C2628","type":"HCPCS"},{"code":"S000447418","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16481.00,"discounted_cash":16481.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2867.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2867.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2505.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4614.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2142.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4120.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1812.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2439.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1812.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2801.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4252.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2801.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1812.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7251.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2999.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7251.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3790.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3790.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3296.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3296.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5273.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3131.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":12855.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14832.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8240.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14008.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14008.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14008.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8240.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8240.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2636.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":17305.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4532.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7416.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3147.87,"methodology":"percent of total billed charges"}]}]},{"description":"CATH BLNOCC 4MM 20MM ","code_information":[{"code":"C2628","type":"HCPCS"},{"code":"S000447424","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16481.00,"discounted_cash":16481.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2867.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2867.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2505.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4614.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2142.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4120.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1812.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2439.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1812.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2801.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4252.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2801.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1812.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7251.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2999.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7251.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3790.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3790.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3296.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3296.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5273.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3131.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":12855.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14832.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8240.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14008.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14008.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14008.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8240.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8240.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2636.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":17305.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4532.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7416.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3147.87,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DLVRY ACC SYS 105CM ","code_information":[{"code":"S007704511","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":12395.00,"discounted_cash":12395.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2156.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":793.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2156.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1884.04,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":3470.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1611.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3098.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1363.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1834.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1363.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":783.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":780.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2107.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3197.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2107.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1363.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":5453.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2255.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":5453.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2850.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2850.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2479.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2479.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3966.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2355.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":9668.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":11155.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6197.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10535.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10535.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10535.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6197.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6197.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1983.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":13014.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":3408.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5577.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2367.45,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":7437.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DRN 10FR 25CM 8HL ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000886754","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":729.00,"discounted_cash":729.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":126.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":126.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":110.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":204.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":94.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":182.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":80.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":107.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":80.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":123.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":188.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":123.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":80.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":320.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":132.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":320.76,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":167.67,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":167.67,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":145.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":145.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":233.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":138.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":568.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":656.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":364.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":619.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":619.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":619.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":364.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":364.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":116.64,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":765.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":200.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":328.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":139.24,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DRN 12FR 16IN ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000367500","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":52.00,"discounted_cash":52.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":9.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":9.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":7.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":14.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":13.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":22.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":9.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":22.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":11.96,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":11.96,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":16.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":40.56,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":46.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":44.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":44.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":44.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":8.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":54.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":14.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":9.93,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DRN 8FR 25CM ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000204354","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1075.00,"discounted_cash":1075.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":187.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":187.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":163.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":301.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":139.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":268.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":159.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":182.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":277.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":182.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":473.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":195.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":473.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":247.25,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":247.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":215.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":215.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":344.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":204.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":838.50,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":967.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":537.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":913.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":913.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":913.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":537.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":537.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":172.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1128.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":295.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":483.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":205.32,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DRN 8FR 41CM CHL-RO ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000285961","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":970.00,"discounted_cash":970.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":168.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":168.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":147.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":271.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":126.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":242.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":143.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":164.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":250.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":164.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":426.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":176.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":426.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":223.10,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":223.10,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":194.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":194.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":310.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":184.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":756.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":873.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":155.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1018.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":266.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":436.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":185.27,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DRN BLNDL 12F 25CM ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000567831","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2872.00,"discounted_cash":2872.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":499.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":499.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":436.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":804.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":373.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":718.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":315.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":425.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":315.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":488.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":740.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":488.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":315.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1263.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":522.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1263.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":660.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":660.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":574.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":574.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":919.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":545.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2240.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2584.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1436.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2441.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2441.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2441.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1436.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1436.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":459.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3015.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":789.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1292.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":548.55,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DRN THOR 32FR 23IN ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000367505","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":70.00,"discounted_cash":70.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":12.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":12.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":19.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":10.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":18.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":30.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":30.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":16.10,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":16.10,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":14.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":14.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":22.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":13.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":54.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":63.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":35.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":35.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":35.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":11.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":73.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":19.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":31.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":13.37,"methodology":"percent of total billed charges"}]}]},{"description":"CATH DST AXS.060INX132CM ","code_information":[{"code":"S000793812","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":30849.00,"discounted_cash":30849.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":5367.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1974.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":5367.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4689.05,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":8637.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4010.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":7712.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3393.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4565.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3393.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1949.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1943.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5244.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":7959.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5244.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3393.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":13573.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":5614.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":13573.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7095.27,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7095.27,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":6169.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":6169.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":9871.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5861.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":24062.22,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27764.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15424.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":26221.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":26221.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":26221.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15424.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15424.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4935.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":32391.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":8483.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13882.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5892.16,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":18509.40,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 110CM 5FR ","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"S000796549","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2437.00,"discounted_cash":2437.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":424.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":424.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":370.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":682.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":316.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":609.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":268.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":360.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":268.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":414.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":628.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":414.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":268.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1072.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":443.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1072.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":560.51,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":560.51,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":487.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":487.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":779.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":463.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1900.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2193.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1218.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2071.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2071.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2071.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1218.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1218.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":389.92,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2558.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":670.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1096.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":465.47,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 115CM 6FR ","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"S000192255","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":481.00,"discounted_cash":481.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":83.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":83.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":73.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":134.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":62.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":120.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":52.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":71.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":52.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":81.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":124.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":81.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":52.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":87.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":110.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":110.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":96.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":96.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":153.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":91.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":375.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":432.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":240.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":408.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":408.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":408.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":240.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":240.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":76.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":505.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":132.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":216.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":91.87,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 5FR 110CM ","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"S000380042","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":481.00,"discounted_cash":481.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":83.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":83.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":73.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":134.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":62.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":120.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":52.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":71.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":52.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":81.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":124.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":81.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":52.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":87.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":110.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":110.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":96.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":96.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":153.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":91.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":375.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":432.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":240.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":408.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":408.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":408.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":240.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":240.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":76.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":505.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":132.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":216.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":91.87,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 6FR 92CM ","code_information":[{"code":"S000614844","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1360.00,"discounted_cash":1360.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":236.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":87.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":236.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":206.72,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":380.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":176.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":340.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":149.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":201.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":149.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":85.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":85.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":231.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":350.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":231.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":149.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":598.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":247.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":598.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":312.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":312.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":272.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":272.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":435.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":258.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1060.80,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1224.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":680.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1156.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1156.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1156.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":680.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":680.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":217.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1428.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":374.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":612.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":259.76,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":816.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 7.5FR 8FR 115CM ","code_information":[{"code":"C1732","type":"HCPCS"},{"code":"S000651231","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38985.00,"discounted_cash":38985.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6783.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6783.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5925.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10915.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5068.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9746.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4288.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5769.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4288.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6627.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":10058.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6627.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4288.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17153.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":7095.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17153.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8966.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8966.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7797.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7797.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12475.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7407.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":30408.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35086.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19492.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19492.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19492.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6237.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":40934.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10720.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17543.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7446.14,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 7FR 110CM ","code_information":[{"code":"C1731","type":"HCPCS"},{"code":"S000895757","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3485.00,"discounted_cash":3485.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":606.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":606.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":529.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":975.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":453.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":871.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":383.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":515.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":383.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":592.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":899.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":592.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":383.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1533.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":634.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1533.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":801.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":801.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":697.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":697.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1115.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":662.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2718.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3136.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1742.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2962.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2962.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2962.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1742.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1742.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":557.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3659.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":958.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1568.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":665.63,"methodology":"percent of total billed charges"}]}]},{"description":"CATH EP 7FR 115CM ","code_information":[{"code":"C1732","type":"HCPCS"},{"code":"S000720129","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27435.00,"discounted_cash":27435.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4773.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4773.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4170.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7681.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3566.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6858.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3017.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4060.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3017.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4663.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":7078.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4663.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3017.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":12071.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4993.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":12071.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6310.05,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6310.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5487.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5487.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8779.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5212.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":21399.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24691.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13717.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23319.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23319.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23319.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13717.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13717.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4389.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":28806.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7544.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12345.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5240.09,"methodology":"percent of total billed charges"}]}]},{"description":"CATH FOLEY 3W 16FR 5CC ","code_information":[{"code":"S000366369","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":125.00,"discounted_cash":125.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":21.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":8.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":21.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":35.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","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":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":31.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":13.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":18.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":13.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":7.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":7.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":32.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":13.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":55.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":22.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":55.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":28.75,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":28.75,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":25.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":25.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":40.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":23.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":97.50,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":112.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":62.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","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":"PPO Next","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","plan_name":"COMM","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 Sheriff","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":"Prime Health Sheriff","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":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":20.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":131.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":34.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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","plan_name":"OptionsPPO","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":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":75.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH FOLEY 3W 20FR 5CC ","code_information":[{"code":"S000366338","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":140.00,"discounted_cash":140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":24.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":8.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":24.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":21.28,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":39.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":35.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":20.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":8.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":8.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":23.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":36.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":23.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":61.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":25.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":61.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":32.20,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":32.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":44.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":26.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":109.20,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":126.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":70.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":119.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":119.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":119.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":70.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":70.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":22.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":147.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":38.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":63.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":26.74,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":84.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD .46IN 125CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S007601834","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":18572.00,"discounted_cash":18572.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3231.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3231.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2822.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":5200.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2414.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4643.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2042.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2748.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2042.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3157.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4791.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3157.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2042.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":8171.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3380.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":8171.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4271.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4271.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3714.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3714.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5943.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3528.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":14486.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":16714.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9286.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15786.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15786.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15786.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9286.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9286.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2971.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":19500.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":5107.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8357.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3547.25,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 1.8FR 135CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000671164","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1662.00,"discounted_cash":1662.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":289.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":289.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":252.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":465.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":216.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":182.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":245.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":182.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":282.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":428.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":282.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":182.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":731.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":302.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":731.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":382.26,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":382.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":332.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":332.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":531.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":315.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1296.36,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1495.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1412.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1412.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1412.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":265.92,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1745.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":457.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":747.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":317.44,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 2.6FR 150CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000209525","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2493.00,"discounted_cash":2493.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":433.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":433.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":378.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":698.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":324.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":623.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":274.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":368.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":274.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":423.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":643.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":423.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":274.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1096.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":453.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1096.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":573.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":573.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":498.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":498.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":797.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":473.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1944.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2243.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1246.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2119.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2119.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2119.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1246.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1246.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":398.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2617.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":685.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1121.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":476.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 3.1FR 135CN ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000184094","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1662.00,"discounted_cash":1662.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":289.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":289.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":252.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":465.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":216.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":182.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":245.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":182.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":282.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":428.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":282.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":182.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":731.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":302.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":731.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":382.26,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":382.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":332.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":332.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":531.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":315.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1296.36,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1495.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1412.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1412.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1412.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":265.92,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1745.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":457.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":747.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":317.44,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 50CM 9F ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000006693","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3421.00,"discounted_cash":3421.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":595.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":595.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":519.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":957.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":444.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":855.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":376.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":506.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":376.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":581.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":882.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":581.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":376.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1505.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":622.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1505.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":786.83,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":786.83,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":684.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":684.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1094.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":649.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2668.38,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3078.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1710.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2907.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2907.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2907.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1710.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1710.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":547.36,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3592.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":940.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1539.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":653.41,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 6FR .014IN 120CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000761572","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27096.00,"discounted_cash":27096.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4714.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4714.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4118.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7586.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3522.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6774.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2980.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4010.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2980.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4606.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":6990.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4606.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2980.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":11922.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4931.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":11922.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6232.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6232.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5419.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5419.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8670.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5148.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":21134.88,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24386.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13548.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23031.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23031.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23031.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13548.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13548.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4335.36,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":28450.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7451.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12193.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5175.34,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 6FR 120CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000987398","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5471.00,"discounted_cash":5471.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":951.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":951.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":831.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1531.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":711.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1367.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":601.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":809.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":601.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":930.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":1411.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":930.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":601.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2407.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":995.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2407.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1258.33,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1258.33,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1094.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1094.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1750.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1039.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4267.38,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4923.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2735.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4650.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4650.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4650.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2735.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2735.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":875.36,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":5744.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1504.53,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2461.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1044.96,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 6FR Z2 EBU 4.5 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000351589","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 7.62FR 65CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000184693","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2201.00,"discounted_cash":2201.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":382.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":382.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":334.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":616.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":286.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":550.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":242.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":325.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":242.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":374.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":567.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":374.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":242.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":968.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":400.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":968.44,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":506.23,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":506.23,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":440.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":440.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":704.32,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":418.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1716.78,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1980.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1100.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1870.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1870.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1870.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1100.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1100.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":352.16,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2311.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":605.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":990.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":420.39,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 7FR 59CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000210735","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2438.00,"discounted_cash":2438.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":424.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":424.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":370.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":682.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":316.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":609.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":268.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":360.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":268.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":414.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":629.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":414.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":268.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1072.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":443.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1072.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":560.74,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":560.74,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":487.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":487.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":780.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":463.22,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1901.64,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2194.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1219.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2072.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2072.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2072.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1219.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1219.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":390.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2559.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":670.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1097.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":465.66,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD 9FR 45CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000006671","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3421.00,"discounted_cash":3421.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":595.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":595.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":519.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":957.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":444.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":855.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":376.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":506.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":376.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":581.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":882.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":581.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":376.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1505.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":622.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1505.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":786.83,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":786.83,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":684.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":684.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1094.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":649.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2668.38,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3078.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1710.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2907.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2907.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2907.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1710.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1710.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":547.36,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3592.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":940.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1539.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":653.41,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD AL7.5 5FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000602076","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":693.00,"discounted_cash":693.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":105.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":194.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":90.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":173.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":102.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":178.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":126.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":221.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":131.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":540.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":623.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":110.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":727.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":190.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":311.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":132.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD ALR2 6FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000078107","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":693.00,"discounted_cash":693.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":105.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":194.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":90.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":173.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":102.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":178.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":126.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":221.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":131.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":540.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":623.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":110.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":727.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":190.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":311.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":132.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD FL3 7FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000424321","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD FR3.5 7FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000424332","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD FR4 SH 8FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000425833","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD IMA 6FR 90CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000078168","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":693.00,"discounted_cash":693.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":105.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":194.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":90.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":173.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":102.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":178.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":126.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":221.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":131.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":540.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":623.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":110.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":727.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":190.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":311.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":132.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD LT 5FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000821901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":970.00,"discounted_cash":970.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":168.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":168.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":147.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":271.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":126.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":242.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":143.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":164.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":250.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":164.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":426.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":176.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":426.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":223.10,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":223.10,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":194.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":194.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":310.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":184.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":756.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":873.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":155.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1018.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":266.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":436.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":185.27,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD OD9FR ATN CMND ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000253795","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3850.00,"discounted_cash":3850.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":669.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":669.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":585.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1078.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":500.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":962.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":423.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":569.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":423.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":654.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":993.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":654.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":423.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1694.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":700.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1694.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":885.50,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":885.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":770.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":770.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1232.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":731.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3003.00,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3465.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1925.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3272.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3272.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3272.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1925.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1925.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":616.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4042.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1058.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1732.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":735.35,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD SAR4 6FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000078264","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":693.00,"discounted_cash":693.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":105.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":194.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":90.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":173.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":102.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":178.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":126.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":221.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":131.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":540.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":623.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":110.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":727.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":190.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":311.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":132.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD STD 6FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000078191","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD STDJL3 5FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000585585","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD VASC 6FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000078139","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":693.00,"discounted_cash":693.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":120.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":105.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":194.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":90.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":173.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":102.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":178.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":117.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":126.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":304.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":221.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":131.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":540.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":623.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":346.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":110.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":727.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":190.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":311.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":132.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 FL4.5 6F 100 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000351601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 FR5 8FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000425836","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 IMA 6FR 100 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000030643","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 LCB 8FR 100CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000425881","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 MAC3.5 6F 100 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000351680","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 RC3.5 6FR 100 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000351723","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH GD Z2 RCB 8FR 90CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000425900","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATH INFS 2.8FR 3.2FR ","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"S000426608","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":13503.00,"discounted_cash":13503.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2349.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2349.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2052.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":3780.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1755.39,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3375.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1485.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1998.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1485.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2295.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3483.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2295.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1485.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":5941.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2457.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":5941.32,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3105.69,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3105.69,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2700.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2700.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4320.96,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2565.57,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":10532.34,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":12152.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6751.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11477.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11477.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11477.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6751.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6751.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2160.48,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":14178.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":3713.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6076.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2579.07,"methodology":"percent of total billed charges"}]}]},{"description":"CATH INFS 5FR 135CM ","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"S000500851","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1787.00,"discounted_cash":1787.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":310.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":310.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":271.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":500.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":232.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":446.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":196.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":264.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":196.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":303.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":461.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":303.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":196.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":786.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":325.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":786.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":411.01,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":411.01,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":357.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":357.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":571.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":339.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1393.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1608.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1518.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1518.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1518.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":285.92,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1876.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":491.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":804.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":341.32,"methodology":"percent of total billed charges"}]}]},{"description":"CATH INTERMDT 160CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007601830","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":23906.00,"discounted_cash":23906.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4159.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4159.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":3633.71,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":6693.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3107.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":5976.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2629.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":3538.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2629.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4064.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":6167.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4064.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2629.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":10518.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4350.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":10518.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5498.38,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5498.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":4781.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":4781.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":7649.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4542.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":18646.68,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":21515.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11953.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":20320.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":20320.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":20320.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11953.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11953.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":3824.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":25101.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":6574.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10757.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4566.05,"methodology":"percent of total billed charges"}]}]},{"description":"CATH IV 16GA X 1.25IN ","code_information":[{"code":"S001089014","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":27.00,"discounted_cash":27.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4.10,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":6.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6.21,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":21.06,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":28.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5.16,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.20,"methodology":"percent of total billed charges"}]}]},{"description":"CATH IVL 2.5MM 80MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S008821198","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65091.00,"discounted_cash":65091.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11325.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11325.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":9893.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":18225.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8461.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16272.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7160.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":9633.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7160.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11065.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":16793.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11065.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7160.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28640.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":11846.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28640.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14970.93,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14970.93,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":13018.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":13018.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20829.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":12367.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":50770.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":58581.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32545.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55327.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55327.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55327.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32545.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32545.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":10414.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":68345.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17900.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":29290.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12432.38,"methodology":"percent of total billed charges"}]}]},{"description":"CATH IVL 3.5X12MM ","code_information":[{"code":"C1761","type":"HCPCS"},{"code":"S007861882","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":65091.00,"discounted_cash":65091.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11325.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4165.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11325.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":9893.83,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":18225.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8461.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16272.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7160.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":9633.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7160.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4113.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4100.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11065.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":16793.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11065.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7160.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28640.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":11846.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28640.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14970.93,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14970.93,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":13018.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":13018.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20829.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":12367.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":50770.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":58581.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32545.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55327.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55327.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55327.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32545.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32545.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":10414.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":68345.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17900.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":29290.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12432.38,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":39054.60,"methodology":"percent of total billed charges"}]}]},{"description":"CATH LIVER BX G08283 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000439500","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4702.00,"discounted_cash":4702.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":818.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":818.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":714.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1316.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":611.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1175.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":517.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":695.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":517.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":799.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":1213.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":799.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":517.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2068.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":855.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2068.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1081.46,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1081.46,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":940.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":940.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1504.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":893.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3667.56,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4231.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2351.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3996.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3996.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3996.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2351.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2351.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":752.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4937.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1293.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2115.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":898.08,"methodology":"percent of total billed charges"}]}]},{"description":"CATH LIVER BX G08284 ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000634681","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5172.00,"discounted_cash":5172.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":899.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":899.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":786.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1448.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":672.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1293.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":568.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":765.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":568.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":879.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":1334.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":879.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":568.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2275.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":941.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2275.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1189.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1189.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1034.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1034.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1655.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":982.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4034.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4654.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2586.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4396.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4396.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4396.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2586.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2586.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":827.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":5430.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1422.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2327.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":987.85,"methodology":"percent of total billed charges"}]}]},{"description":"CATH MAPPING 2.0CM ","code_information":[{"code":"C1732","type":"HCPCS"},{"code":"S007594612","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":39152.00,"discounted_cash":39152.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6812.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6812.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5951.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10962.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5089.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9788.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4306.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5794.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4306.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6655.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":10101.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6655.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4306.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17226.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":7125.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17226.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9004.96,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9004.96,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7830.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7830.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12528.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7438.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":30538.56,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35236.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19576.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33279.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33279.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33279.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19576.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19576.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6264.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":41109.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10766.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17618.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7478.03,"methodology":"percent of total billed charges"}]}]},{"description":"CATH MAPPING 3.0CM ","code_information":[{"code":"C1732","type":"HCPCS"},{"code":"S007596381","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":39152.00,"discounted_cash":39152.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6812.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6812.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5951.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10962.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5089.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9788.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4306.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5794.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4306.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6655.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":10101.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6655.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4306.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17226.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":7125.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17226.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9004.96,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9004.96,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7830.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7830.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12528.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7438.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":30538.56,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35236.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19576.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33279.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33279.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33279.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19576.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19576.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6264.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":41109.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10766.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17618.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7478.03,"methodology":"percent of total billed charges"}]}]},{"description":"CATH MLCT 26FR 4-WING ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000366251","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":138.00,"discounted_cash":138.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":24.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":24.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":20.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":38.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":17.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":34.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":20.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":23.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":35.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":23.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":60.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":25.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":60.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":31.74,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":31.74,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":27.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":27.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":44.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":26.22,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":107.64,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":124.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":69.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":117.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":117.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":117.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":69.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":69.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":22.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":144.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":37.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":62.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":26.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH NPHSTM 8FR 52CM ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000204255","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":845.00,"discounted_cash":845.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":147.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":147.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":128.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":236.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":109.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":211.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":92.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":125.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":92.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":143.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":218.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":143.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":92.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":371.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":153.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":371.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":194.35,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":194.35,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":169.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":169.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":270.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":160.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":659.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":760.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":422.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":718.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":718.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":718.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":422.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":422.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":135.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":887.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":232.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":380.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":161.40,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PLC/INJ BYPAS GRFTS ","code_information":[{"code":"C000024301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":17035.60,"discounted_cash":17035.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1090.28,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4769.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2214.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4258.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1076.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1073.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7495.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3100.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7495.66,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3918.19,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3918.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5451.39,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3236.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":13287.77,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15332.04,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8517.80,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14480.26,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14480.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14480.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8517.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8517.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":17887.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7666.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3253.80,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10221.36,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PRF24MMX3.5CM 110CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001114157","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16619.00,"discounted_cash":16619.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2891.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2891.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2526.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4653.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2160.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4154.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1828.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2459.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1828.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2825.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4287.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2825.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1828.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7312.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3024.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7312.36,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3822.37,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3822.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3323.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3323.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5318.08,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3157.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":12962.82,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14957.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8309.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14126.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14126.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14126.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8309.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8309.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2659.04,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":17449.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4570.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7478.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3174.23,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTA 3X40MM 150CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000697043","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10041.00,"discounted_cash":10041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1526.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2811.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1305.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2510.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1486.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2590.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1827.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3213.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1907.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7831.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9036.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1606.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10543.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2761.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4518.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1917.83,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTA 6F 5X40MM 120CM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000052772","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10041.00,"discounted_cash":10041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1526.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2811.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1305.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2510.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1486.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2590.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1827.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3213.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1907.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7831.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9036.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1606.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10543.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2761.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4518.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1917.83,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTA BLN 2.5X9MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001346615","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":15036.00,"discounted_cash":15036.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2616.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2285.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4210.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1954.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3759.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2225.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3879.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2556.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1653.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2736.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6615.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3458.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3007.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4811.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2856.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":11728.08,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13532.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12780.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7518.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2405.76,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":15787.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4134.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6766.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2871.88,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTCA BLN 1.5MMX15MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000437435","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1081.00,"discounted_cash":1081.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":164.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":302.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":140.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":270.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":159.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":278.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":196.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":345.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":205.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":843.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":972.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":172.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1135.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":297.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":486.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":206.47,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTCA BLN 2.0MMX20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000437444","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1081.00,"discounted_cash":1081.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":164.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":302.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":140.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":270.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":159.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":278.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":196.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":345.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":205.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":843.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":972.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":172.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1135.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":297.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":486.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":206.47,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTCA BLN 3.5MMX15MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000437515","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1081.00,"discounted_cash":1081.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":164.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":302.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":140.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":270.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":159.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":278.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":196.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":345.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":205.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":843.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":972.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":172.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1135.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":297.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":486.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":206.47,"methodology":"percent of total billed charges"}]}]},{"description":"CATH PTCA BLN 4.0MMX20MM ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S000437550","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1081.00,"discounted_cash":1081.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":188.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":164.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":302.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":140.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":270.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":159.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":278.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":183.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":196.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":475.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":248.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":216.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":345.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":205.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":843.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":972.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":918.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":540.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":172.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1135.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":297.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":486.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":206.47,"methodology":"percent of total billed charges"}]}]},{"description":"CATH SHNT PSSR SBQ 38CM ","code_information":[{"code":"S000504126","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1805.00,"discounted_cash":1805.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":314.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":115.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":314.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":274.36,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":505.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":234.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":451.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":198.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":267.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":198.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":114.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":113.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":306.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":465.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":306.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":198.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":794.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":328.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":794.20,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":415.15,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":415.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":361.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":361.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":577.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":342.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1407.90,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1624.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":902.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1534.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1534.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1534.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":902.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":902.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":288.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1895.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":496.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":812.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":344.75,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1083.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH SHUNT PRNTL 120CM ","code_information":[{"code":"S000018584","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":730.00,"discounted_cash":730.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":46.72,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":204.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":94.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":182.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":46.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":45.99,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":233.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":569.40,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":657.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":365.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":620.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":620.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":620.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":365.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":365.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":766.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":200.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":328.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":139.43,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":438.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH SLITTER 4-6FR ","code_information":[{"code":"S000626417","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":250.00,"discounted_cash":250.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":43.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":43.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":38.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":70.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":62.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":27.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":37.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":27.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":15.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":15.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":42.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":64.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":42.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":27.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":110.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":45.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":110.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":57.50,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":57.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":80.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":47.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":195.00,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":225.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":125.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":212.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":212.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":212.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":125.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":125.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":40.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":262.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":68.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":112.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":47.75,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":150.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH SLITTER UNV 2 ","code_information":[{"code":"S000088780","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":347.00,"discounted_cash":347.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":60.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":22.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":60.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":52.74,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":97.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":45.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":86.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":38.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":51.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":38.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":21.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":21.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":58.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":89.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":58.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":38.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":152.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":63.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":152.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":79.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":79.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":69.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":69.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":111.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":65.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":270.66,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":312.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":173.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":294.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":294.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":294.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":173.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":173.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":55.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":364.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":95.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":156.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":66.28,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":208.20,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THMB 2F 0.67MM 60CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007317688","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":831.00,"discounted_cash":831.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":144.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":144.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":126.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":232.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":108.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":207.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":122.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":141.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":214.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":141.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":91.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":365.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":151.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":365.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":191.13,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":191.13,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":166.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":166.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":265.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":157.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":648.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":747.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":706.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":706.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":706.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":415.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":132.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":872.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":228.53,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":373.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":158.72,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THOR STR 40FR ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000181109","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":72.00,"discounted_cash":72.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":12.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":12.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":10.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":20.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":10.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":18.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":31.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":13.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":31.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":16.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":16.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":14.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":14.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":23.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":13.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":56.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":64.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":61.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":61.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":61.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":11.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":75.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":19.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":32.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":13.75,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THOR STR 40FR ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000367507","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":75.00,"discounted_cash":75.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":13.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":13.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":11.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":11.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":19.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":15.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":15.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":14.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":67.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":78.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":20.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THORACIC DRAC-28S ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000420918","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":202.00,"discounted_cash":202.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":35.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":35.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":30.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":56.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":26.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":50.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":22.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":29.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":22.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":52.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":22.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":88.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":36.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":88.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":46.46,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":46.46,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":40.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":40.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":64.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":38.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":157.56,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":181.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":171.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":171.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":171.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":101.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":32.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":212.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":55.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":90.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":38.58,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 100CM 135CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007789721","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":99999.00,"discounted_cash":99999.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":17399.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":17399.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":15199.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":27999.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12999.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":24999.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":10999.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":14799.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":10999.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":16999.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":25799.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":16999.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":10999.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":43999.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":18199.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":43999.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22999.77,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22999.77,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":19999.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":19999.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":31999.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":18999.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":77999.22,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":89999.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49999.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":84999.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":84999.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":84999.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49999.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49999.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":15999.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":104998.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":27499.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":44999.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":19099.81,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 115CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S002603376","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":28045.00,"discounted_cash":28045.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4879.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4879.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4262.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7852.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3645.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":7011.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3084.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4150.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3084.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4767.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":7235.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4767.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3084.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":12339.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":5104.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":12339.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6450.35,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6450.35,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5609.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5609.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8974.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5328.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":21875.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":25240.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14022.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23838.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23838.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23838.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14022.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14022.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4487.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":29447.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7712.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12620.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5356.60,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 125CM 6X5.6FR ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S000785349","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1704.00,"discounted_cash":1704.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":296.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":296.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":259.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":477.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":221.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":426.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":187.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":252.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":187.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":289.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":439.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":289.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":187.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":749.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":310.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":749.76,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":391.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":391.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":340.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":340.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":545.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":323.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1329.12,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1533.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":852.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1448.40,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1448.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1448.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":852.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":852.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":272.64,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1789.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":468.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":766.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":325.46,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 137CM .071IN ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007431817","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":34415.00,"discounted_cash":34415.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":5988.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":5988.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5231.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":9636.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4473.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8603.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3785.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5093.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3785.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5850.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":8879.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5850.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3785.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":15142.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6263.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":15142.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7915.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7915.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":6883.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":6883.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":11012.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":6538.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":26843.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":30973.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17207.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29252.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29252.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29252.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17207.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17207.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":5506.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":36135.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":9464.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15486.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6573.27,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 6FR 135CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S000558654","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27560.00,"discounted_cash":27560.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4795.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4795.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4189.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7716.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3582.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6890.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3031.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4078.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3031.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4685.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":7110.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4685.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3031.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":12126.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":5015.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":12126.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6338.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6338.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5512.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5512.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8819.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5236.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":21496.80,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24804.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13780.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23426.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23426.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":23426.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13780.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13780.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4409.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":28938.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7579.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12402.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5263.96,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 7FR 130CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007442553","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":76031.00,"discounted_cash":76031.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":13229.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":13229.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":11556.71,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":21288.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9884.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":19007.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8363.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":11252.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8363.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12925.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":19616.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12925.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8363.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":33453.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":13837.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":33453.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17487.13,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17487.13,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":15206.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":15206.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":24329.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":14445.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":59304.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":68427.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38015.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":64626.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":64626.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":64626.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38015.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38015.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":12164.96,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":79832.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":20908.53,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":34213.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14521.92,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 80CM 105CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007779658","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":99999.00,"discounted_cash":99999.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":17399.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":17399.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":15199.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":27999.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12999.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":24999.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":10999.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":14799.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":10999.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":16999.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":25799.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":16999.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":10999.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":43999.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":18199.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":43999.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22999.77,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22999.77,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":19999.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":19999.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":31999.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":18999.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":77999.22,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":89999.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49999.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":84999.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":84999.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":84999.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49999.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49999.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":15999.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":104998.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":27499.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":44999.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":19099.81,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THRMB 8FR 115CM ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007309247","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":78801.00,"discounted_cash":78801.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":13711.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":13711.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":11977.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":22064.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":10244.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":19700.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8668.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":11662.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8668.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":13396.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":20330.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":13396.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8668.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":34672.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":14341.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":34672.44,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":18124.23,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":18124.23,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":15760.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":15760.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":25216.32,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":14972.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":61464.78,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":70920.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39400.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":66980.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":66980.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":66980.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39400.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39400.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":12608.16,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":82741.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":21670.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":35460.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":15050.99,"methodology":"percent of total billed charges"}]}]},{"description":"CATH THROM REPFUSN ","code_information":[{"code":"C1757","type":"HCPCS"},{"code":"S007494128","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38085.00,"discounted_cash":38085.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5788.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10663.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4951.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9521.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5636.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":9825.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6931.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12187.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7236.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":29706.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34276.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6093.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":39989.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10473.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17138.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7274.23,"methodology":"percent of total billed charges"}]}]},{"description":"CATH TRAY 16CM 11.5FR ","code_information":[{"code":"S002361833","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":970.00,"discounted_cash":970.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":168.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":62.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":168.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":147.44,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":271.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":126.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":242.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":143.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":61.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":61.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":164.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":250.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":164.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":106.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":426.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":176.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":426.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":223.10,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":223.10,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":194.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":194.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":310.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":184.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":756.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":873.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":824.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":485.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":155.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1018.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":266.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":436.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":185.27,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":582.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH ULTSND 5.0MM 60 MM ","code_information":[{"code":"C1753","type":"HCPCS"},{"code":"S002581869","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38085.00,"discounted_cash":38085.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5788.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10663.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4951.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9521.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5636.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":9825.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6931.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12187.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7236.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":29706.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34276.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6093.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":39989.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10473.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17138.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7274.23,"methodology":"percent of total billed charges"}]}]},{"description":"CATH ULTSND 5.5MM 60 MM ","code_information":[{"code":"C1753","type":"HCPCS"},{"code":"S002581873","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38085.00,"discounted_cash":38085.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5788.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10663.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4951.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9521.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5636.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":9825.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6931.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12187.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7236.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":29706.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34276.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6093.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":39989.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10473.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17138.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7274.23,"methodology":"percent of total billed charges"}]}]},{"description":"CATH ULTSND 6.5MM 60 MM ","code_information":[{"code":"C1753","type":"HCPCS"},{"code":"S002581855","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38085.00,"discounted_cash":38085.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6626.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5788.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10663.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4951.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9521.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5636.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":9825.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6474.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4189.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6931.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16757.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8759.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7617.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12187.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7236.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":29706.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34276.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32372.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19042.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6093.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":39989.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10473.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17138.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7274.23,"methodology":"percent of total billed charges"}]}]},{"description":"CATH URET 12FE 5CC ","code_information":[{"code":"S000366324","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":2.00,"discounted_cash":2.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":0.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":0.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":0.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":0.30,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":0.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":0.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":0.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":0.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":0.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":0.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":0.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":0.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":0.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":0.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":0.46,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":0.46,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":0.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":0.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":0.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":0.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1.56,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":0.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":0.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":0.38,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1.20,"methodology":"percent of total billed charges"}]}]},{"description":"CATH URET 20FR 2W 5CC ","code_information":[{"code":"S000366316","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":115.00,"discounted_cash":115.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":20.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":7.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":20.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":17.48,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":32.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":28.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":17.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":7.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":7.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":19.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":29.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":19.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":50.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":20.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":50.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":26.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":26.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":23.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":23.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":36.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":21.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":89.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":103.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":97.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":97.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":97.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":18.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":120.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":31.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":51.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.96,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":69.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH URET 2W 20FR 30CC ","code_information":[{"code":"S000406086","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":183.00,"discounted_cash":183.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":31.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":11.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":31.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":27.82,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":51.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":23.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":45.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":20.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":27.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":20.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":11.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":11.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":31.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":47.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":31.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":20.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":80.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":33.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":80.52,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":42.09,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":42.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":36.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":36.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":58.56,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":34.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":142.74,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":164.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":91.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":155.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":155.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":155.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":91.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":91.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":29.28,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":192.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":50.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":82.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":34.95,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":109.80,"methodology":"percent of total billed charges"}]}]},{"description":"CATH URTH FOL 20FR 2W ","code_information":[{"code":"S000765520","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":200.00,"discounted_cash":200.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":34.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":12.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":34.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":30.40,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":56.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":26.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":22.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":29.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":22.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":12.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":12.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":34.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":51.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":34.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":22.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":88.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":36.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":88.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":46.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":46.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":40.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":40.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":64.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":38.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":156.00,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":180.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":100.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":170.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":170.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":170.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":100.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":100.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":32.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":210.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":55.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":90.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":38.20,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":120.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH VASC MCR 6F 95CM ","code_information":[{"code":"S000355515","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":12395.00,"discounted_cash":12395.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2156.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":793.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2156.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1884.04,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":3470.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1611.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3098.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1363.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1834.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1363.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":783.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":780.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2107.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3197.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2107.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1363.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":5453.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2255.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":5453.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2850.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2850.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2479.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2479.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3966.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2355.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":9668.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":11155.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6197.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10535.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10535.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10535.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6197.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6197.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1983.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":13014.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":3408.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5577.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2367.45,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":7437.00,"methodology":"percent of total billed charges"}]}]},{"description":"CATH VASC STRT 6.0X150CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000184807","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17117.00,"discounted_cash":17117.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2978.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2978.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2601.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4792.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2225.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4279.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1882.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2533.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1882.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2909.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4416.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2909.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1882.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7531.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3115.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":7531.48,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3936.91,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3936.91,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3423.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3423.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5477.44,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3252.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":13351.26,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15405.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8558.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14549.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14549.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":14549.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8558.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8558.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2738.72,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":17972.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4707.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7702.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3269.35,"methodology":"percent of total billed charges"}]}]},{"description":"CATH VENT 1.5FR 33CM ","code_information":[{"code":"C1729","type":"HCPCS"},{"code":"S000001158","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3410.00,"discounted_cash":3410.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":593.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":593.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":518.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":954.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":443.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":852.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":375.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":504.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":375.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":579.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":879.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":579.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":375.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1500.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":620.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1500.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":784.30,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":784.30,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":682.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":682.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1091.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":647.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2659.80,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3069.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1705.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2898.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2898.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2898.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1705.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1705.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":545.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3580.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":937.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1534.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":651.31,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER BLN 3MMX15MM ","code_information":[{"code":"C2628","type":"HCPCS"},{"code":"S000297578","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":18392.00,"discounted_cash":18392.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3200.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3200.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2795.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":5149.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2390.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4598.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2023.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2722.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2023.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3126.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":4745.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3126.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2023.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":8092.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3347.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":8092.48,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4230.16,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4230.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3678.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":3678.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5885.44,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":3494.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":14345.76,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":16552.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9196.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15633.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15633.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15633.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9196.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9196.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2942.72,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":19311.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":5057.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8276.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3512.87,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER BLNDIL 2MM 140C ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001202361","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10041.00,"discounted_cash":10041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1526.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2811.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1305.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2510.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1486.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2590.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1827.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3213.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1907.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7831.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9036.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1606.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10543.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2761.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4518.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1917.83,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER BLNDIL 2MM 140C ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001202362","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10041.00,"discounted_cash":10041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1526.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2811.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1305.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2510.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1486.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2590.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1827.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3213.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1907.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7831.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9036.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1606.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10543.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2761.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4518.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1917.83,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER BLNDIL 3MM 140C ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001202367","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10041.00,"discounted_cash":10041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1526.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2811.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1305.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2510.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1486.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2590.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1827.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3213.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1907.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7831.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9036.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1606.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10543.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2761.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4518.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1917.83,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER BLNDIL 3MM 140C ","code_information":[{"code":"C1725","type":"HCPCS"},{"code":"S001202368","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10041.00,"discounted_cash":10041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1747.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1526.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2811.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1305.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2510.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1486.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2590.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1706.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1104.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1827.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4418.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2309.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":2008.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3213.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1907.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7831.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9036.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8534.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5020.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1606.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10543.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2761.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4518.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1917.83,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER CV INDWL SLT ","code_information":[{"code":"S000232634","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":2072.00,"discounted_cash":2072.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":360.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":132.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":360.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":314.94,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":580.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":269.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":518.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":227.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":306.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":227.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":130.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":130.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":352.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":534.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":352.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":227.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":911.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":377.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":911.68,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":476.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":476.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":414.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":414.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":663.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":393.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1616.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1864.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1036.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1761.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1761.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1761.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1036.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1036.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":331.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2175.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":569.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":932.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":395.75,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1243.20,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER DUAL LUMEN 28FR ","code_information":[{"code":"C1751","type":"HCPCS"},{"code":"S002665615","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":34623.00,"discounted_cash":34623.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6024.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6024.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5262.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":9694.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4500.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8655.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3808.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5124.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3808.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5885.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":8932.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5885.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3808.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":15234.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6301.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":15234.12,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7963.29,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7963.29,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":6924.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":6924.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":11079.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":6578.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":27005.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31160.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17311.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29429.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29429.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":29429.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17311.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":17311.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":5539.68,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":36354.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":9521.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15580.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6612.99,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER EP 7.5FR CRTO 3 ","code_information":[{"code":"C1732","type":"HCPCS"},{"code":"S000651361","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38985.00,"discounted_cash":38985.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6783.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6783.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5925.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10915.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5068.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9746.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4288.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5769.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4288.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6627.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":10058.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6627.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4288.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17153.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":7095.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17153.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8966.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8966.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7797.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7797.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12475.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7407.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":30408.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35086.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19492.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19492.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19492.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6237.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":40934.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10720.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17543.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7446.14,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER EP 7FR 115CM ","code_information":[{"code":"C1730","type":"HCPCS"},{"code":"S000109039","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1609.00,"discounted_cash":1609.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":279.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":279.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":244.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":450.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":209.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":402.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":176.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":238.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":176.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":273.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":415.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":273.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":176.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":707.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":292.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":707.96,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":370.07,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":370.07,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":321.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":321.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":514.88,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":305.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1255.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1448.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":804.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1367.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1367.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1367.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":804.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":804.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":257.44,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1689.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":442.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":724.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":307.32,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER GD 100CM 6FR ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000351581","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER GD 115CM 7FR ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S002979942","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":23315.00,"discounted_cash":23315.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4056.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4056.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":3543.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":6528.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3030.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":5828.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2564.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":3450.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2564.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3963.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":6015.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3963.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2564.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":10258.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4243.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":10258.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5362.45,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5362.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":4663.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":4663.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":7460.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4429.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":18185.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20983.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11657.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19817.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19817.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19817.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11657.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11657.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":3730.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":24480.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":6411.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10491.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4453.17,"methodology":"percent of total billed charges"}]}]},{"description":"CATHETER GD ARI 100CM 6F ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000351561","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":582.00,"discounted_cash":582.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":101.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":88.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":162.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":75.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":86.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":150.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":105.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":256.08,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":133.86,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":116.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":186.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":453.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":523.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":494.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":93.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":611.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":160.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":111.16,"methodology":"percent of total billed charges"}]}]},{"description":"CEFDINIR 125 MG /5 ML SU ","code_information":[{"code":"P000643902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":21.25,"discounted_cash":21.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":3.23,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":5.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":5.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":3.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":5.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":9.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":3.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":9.35,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4.89,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4.89,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":4.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":4.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":6.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":16.57,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10.63,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.06,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.06,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.06,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":10.63,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":3.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":22.31,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":5.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.06,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"}]}]},{"description":"CEFIDEROCOL 1 G INJ ","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"J0699","type":"HCPCS"},{"code":"P000085701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1317.95,"discounted_cash":1317.95,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":369.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":171.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":329.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":144.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":195.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":144.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":224.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":340.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":224.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":144.97,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":303.13,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":421.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1028.00,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1186.15,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":658.98,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1120.26,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1120.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1120.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":658.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":658.98,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":210.87,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1383.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":362.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":593.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":251.73,"methodology":"percent of total billed charges"}]}]},{"description":"CEFTAZ/AVIBCT 2.5 G INJ ","drug_information":{"unit":"2.5","type":"GM"},"code_information":[{"code":"J0714","type":"HCPCS"},{"code":"P000088601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1638.50,"discounted_cash":1638.50,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":458.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":213.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":409.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":180.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":242.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":180.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":278.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":422.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":278.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":180.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":376.86,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":524.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1278.03,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1474.65,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":819.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1392.72,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1392.72,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1392.72,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":819.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":819.25,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":262.16,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1720.42,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":450.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":737.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":312.95,"methodology":"percent of total billed charges"}]}]},{"description":"CEFTRIAXONE 2 G INJ ","drug_information":{"unit":"2","type":"GM"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"P000083402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":74.00,"discounted_cash":74.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":20.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":10.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":19.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.14,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.02,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":23.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":57.72,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":66.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":62.90,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":62.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":62.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":11.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":77.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":20.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.13,"methodology":"percent of total billed charges"}]}]},{"description":"CELL CT & DIFF CSF ","code_information":[{"code":"89051","type":"CPT"},{"code":"L000426701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1105.05,"discounted_cash":1105.05,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":309.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":143.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":276.26,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":254.16,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":254.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":221.01,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":221.01,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":353.62,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":209.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":861.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":994.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":552.52,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":939.29,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":939.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":939.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":552.52,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":552.52,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":176.81,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1160.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":303.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":497.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":211.06,"methodology":"percent of total billed charges"}]}]},{"description":"CEMENT BN CA PHS HA 10CC ","code_information":[{"code":"S001491763","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":10770.00,"discounted_cash":10770.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":689.28,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":3015.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1400.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2692.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":680.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":678.51,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3446.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":8400.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9693.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5385.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9154.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9154.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9154.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5385.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5385.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":11308.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2961.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4846.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2057.07,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":6462.00,"methodology":"percent of total billed charges"}]}]},{"description":"CEMENT BN CALC PHOS 5CC ","code_information":[{"code":"S002822683","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":7719.00,"discounted_cash":7719.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":494.02,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2161.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1003.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1929.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":487.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":486.30,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2470.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":6020.82,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6947.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3859.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6561.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6561.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6561.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3859.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3859.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":8104.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2122.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3473.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1474.33,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4631.40,"methodology":"percent of total billed charges"}]}]},{"description":"CEMENT MIXER 120GM ","code_information":[{"code":"S000093058","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":3449.00,"discounted_cash":3449.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":600.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":220.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":600.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":524.25,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":965.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":448.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":862.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":379.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":510.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":379.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":217.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":217.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":586.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":889.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":586.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":379.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1517.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":627.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1517.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":793.27,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":793.27,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":689.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":689.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1103.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":655.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2690.22,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3104.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1724.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2931.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2931.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2931.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1724.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1724.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":551.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3621.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":948.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1552.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":658.76,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2069.40,"methodology":"percent of total billed charges"}]}]},{"description":"CENTER PIECE 16X23 SZ C ","code_information":[{"code":"S000920784","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":14809.00,"discounted_cash":14809.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":947.78,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4146.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1925.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3702.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":935.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":932.97,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4738.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":11551.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13328.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7404.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12587.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12587.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12587.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7404.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7404.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":15549.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4072.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6664.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2828.52,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":8885.40,"methodology":"percent of total billed charges"}]}]},{"description":"CENTRALIZR STEM HIP 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000570346","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":258.00,"discounted_cash":258.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":72.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":33.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":64.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":82.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":201.24,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":232.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":129.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":219.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":219.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":219.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":129.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":129.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":270.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":70.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":116.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":49.28,"methodology":"percent of total billed charges"}]}]},{"description":"CENTRLZR DSTL 13MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001171877","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":234.00,"discounted_cash":234.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":65.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":30.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":74.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":182.52,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":210.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":117.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":198.90,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":198.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":198.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":117.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":117.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":245.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":64.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":105.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":44.69,"methodology":"percent of total billed charges"}]}]},{"description":"CEPHALEX 250MG/5ML LIQ ","code_information":[{"code":"P000525502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":11.30,"discounted_cash":11.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":0.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1.72,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":3.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":0.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":0.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4.97,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3.62,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":8.81,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":10.17,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9.61,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5.65,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1.81,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":11.87,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":3.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5.09,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2.16,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":6.78,"methodology":"percent of total billed charges"}]}]},{"description":"CHEST WALL INITIAL ","code_information":[{"code":"94667","type":"CPT"},{"code":"R000005901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":539.20,"discounted_cash":539.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":93.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":93.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":81.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":150.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":70.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":134.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":59.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":79.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":59.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":91.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":139.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":91.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":59.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":237.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":98.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":237.25,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":124.02,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":124.02,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":107.84,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":107.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":172.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":102.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":420.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":485.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":269.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":458.32,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":458.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":458.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":269.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":269.60,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":86.27,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":566.16,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":148.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":242.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":102.99,"methodology":"percent of total billed charges"}]}]},{"description":"CHEST XRAY 1 V ","code_information":[{"code":"71045","type":"CPT"},{"code":"I000068903","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1303.80,"discounted_cash":1303.80,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":365.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":169.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":325.95,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":299.87,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":299.87,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":260.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":260.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":417.22,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":247.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1016.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1173.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":651.90,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1108.23,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1108.23,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1108.23,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":651.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":651.90,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":208.61,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1368.99,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":358.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":586.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":249.03,"methodology":"percent of total billed charges"}]}]},{"description":"CHIKUNGUNYA AB IGM ","code_information":[{"code":"86790","type":"CPT"},{"code":"L000318502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":55.25,"discounted_cash":55.25,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":15.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.81,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.71,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.71,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":11.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":11.05,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":17.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":10.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":43.09,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":49.73,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.63,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":46.96,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":46.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":46.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.63,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":58.01,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":15.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":24.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":10.55,"methodology":"percent of total billed charges"}]}]},{"description":"CHLAMYDIA P AMP PROBE ","code_information":[{"code":"87486","type":"CPT"},{"code":"L000365202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":150.60,"discounted_cash":150.60,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":42.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":19.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":37.65,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":34.64,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":34.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":30.12,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":30.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":48.19,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":117.47,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":135.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":128.01,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":128.01,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":128.01,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.30,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":24.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":158.13,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":41.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":67.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":28.76,"methodology":"percent of total billed charges"}]}]},{"description":"CHLAMYDIA TRACH IGM ","code_information":[{"code":"86632","type":"CPT"},{"code":"L000286902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":93.60,"discounted_cash":93.60,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":26.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":21.53,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":21.53,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":18.72,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":18.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":29.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":17.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":73.01,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":84.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":46.80,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":79.56,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":79.56,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":79.56,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":46.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":46.80,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":14.98,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":98.28,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":25.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":42.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":17.88,"methodology":"percent of total billed charges"}]}]},{"description":"CHLORDIAZEPOXID 25MG CAP ","code_information":[{"code":"P000525902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":32.45,"discounted_cash":32.45,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":5.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":2.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":5.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":4.93,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":9.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":4.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":2.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":2.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":8.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":5.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":3.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":14.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":14.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":10.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":6.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":25.31,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":29.21,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.23,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27.58,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":5.19,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":34.07,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":8.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":14.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6.20,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":19.47,"methodology":"percent of total billed charges"}]}]},{"description":"CHLORIDE BLD ","code_information":[{"code":"82435","type":"CPT"},{"code":"L000095901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":337.15,"discounted_cash":337.15,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":94.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":43.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":84.29,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":77.54,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":77.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":67.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":67.43,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":107.89,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":64.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":262.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":303.43,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":168.57,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":286.58,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":286.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":286.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":168.57,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":168.57,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":53.94,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":354.01,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":92.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":151.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":64.40,"methodology":"percent of total billed charges"}]}]},{"description":"CHLORIDE UR ","code_information":[{"code":"82436","type":"CPT"},{"code":"L000096001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":350.50,"discounted_cash":350.50,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":98.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":45.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":87.63,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":80.61,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":80.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":70.10,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":70.10,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":112.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":66.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":273.39,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":315.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":175.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":297.93,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":297.93,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":297.93,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":175.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":175.25,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":56.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":368.02,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":96.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":157.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":66.95,"methodology":"percent of total billed charges"}]}]},{"description":"CHOLESTEROL BLD ","code_information":[{"code":"82465","type":"CPT"},{"code":"L000096401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":915.65,"discounted_cash":915.65,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":256.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":119.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":228.91,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":210.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":210.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":183.13,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":183.13,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":293.01,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":173.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":714.21,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":824.09,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":457.82,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":778.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":778.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":778.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":457.82,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":457.82,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":146.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":961.43,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":251.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":412.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":174.89,"methodology":"percent of total billed charges"}]}]},{"description":"CILASTATN/IMIPINM 500 MG ","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"P000090901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":444.00,"discounted_cash":444.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":124.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":57.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":111.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":48.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":65.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":48.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":75.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":114.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":75.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":48.84,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":102.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":142.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":346.32,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":399.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":222.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":377.40,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":377.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":377.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":222.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":222.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":71.04,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":466.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":122.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":199.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":84.80,"methodology":"percent of total billed charges"}]}]},{"description":"CIPROFLOXCN 0.3% OPHTH ","code_information":[{"code":"P000527403","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1794.20,"discounted_cash":1794.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":312.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":114.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":312.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":272.72,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":502.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":233.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":448.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":197.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":265.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":197.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":113.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":113.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":305.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":462.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":305.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":197.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":789.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":326.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":789.45,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":574.14,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":340.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1399.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1614.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1525.07,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1525.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1525.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.10,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":287.07,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1883.91,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":493.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":807.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":342.69,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1076.52,"methodology":"percent of total billed charges"}]}]},{"description":"CITALOPRAM 20MG TAB ","code_information":[{"code":"P000527902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":14.30,"discounted_cash":14.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":0.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":2.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":2.17,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":2.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":0.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":0.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":3.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":2.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":2.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":6.29,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":11.15,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":12.87,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7.15,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":2.29,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":15.02,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":3.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2.73,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":8.58,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP 1 HL XTRNFX OCPTL ","code_information":[{"code":"S000099769","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":2487.00,"discounted_cash":2487.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":432.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":159.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":432.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":378.02,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":696.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":323.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":621.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":273.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":368.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":273.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":157.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":156.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":422.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":641.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":422.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":273.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1094.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":452.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1094.28,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":572.01,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":572.01,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":497.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":497.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":795.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":472.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1939.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2238.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1243.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2113.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2113.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2113.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1243.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1243.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":397.92,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2611.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":683.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1119.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":475.02,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1492.20,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP EX FIX 5079-1-010 ","code_information":[{"code":"S000469360","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":8410.00,"discounted_cash":8410.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1463.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":538.24,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1463.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1278.32,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2354.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1093.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2102.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":925.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1244.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":925.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":531.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":529.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1429.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2169.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1429.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":925.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":3700.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1530.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":3700.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1934.30,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1934.30,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1682.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1682.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2691.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1597.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":6559.80,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7569.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4205.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7148.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7148.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7148.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4205.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4205.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1345.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":8830.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2312.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3784.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1606.31,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5046.00,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP EXFX LG 105MM ","code_information":[{"code":"S000753177","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":9646.00,"discounted_cash":9646.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1678.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":617.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1678.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1466.19,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2700.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1253.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2411.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1061.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1427.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1061.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":609.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":607.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1639.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2488.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1639.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1061.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4244.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1755.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":4244.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2218.58,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2218.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1929.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1929.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3086.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1832.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7523.88,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8681.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4823.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8199.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8199.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8199.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4823.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4823.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1543.36,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10128.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2652.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4340.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1842.39,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5787.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP INSERT SET 61MM ","code_information":[{"code":"S000225978","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":180.00,"discounted_cash":180.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":31.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":11.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":31.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":27.36,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":50.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":45.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":19.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":26.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":19.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":11.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":11.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":30.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":46.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":30.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":19.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":79.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":32.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":79.20,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":41.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":41.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":57.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":34.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":140.40,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":162.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":90.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":153.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":153.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":153.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":90.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":90.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":28.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":189.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":49.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":81.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":34.38,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":108.00,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP SURG PP 10MM ","code_information":[{"code":"S000493905","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":100.00,"discounted_cash":100.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":17.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":6.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":17.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":15.20,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":25.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":14.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":6.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":6.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":17.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":25.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":17.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":44.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":44.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":23.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":23.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":20.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":20.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":32.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":78.00,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":90.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":105.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":27.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":45.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":19.10,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":60.00,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP TUBE-TO-TUBE EXFX ","code_information":[{"code":"S000096390","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":6360.00,"discounted_cash":6360.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1106.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":407.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1106.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":966.72,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1780.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":826.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1590.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":699.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":941.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":699.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":401.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":400.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1081.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":1640.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1081.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":699.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2798.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1157.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2798.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1462.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1462.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1272.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1272.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2035.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1208.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4960.80,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5724.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3180.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5406.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5406.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5406.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3180.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3180.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1017.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":6678.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1749.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2862.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1214.76,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3816.00,"methodology":"percent of total billed charges"}]}]},{"description":"CLAMP VASC 33MM ","code_information":[{"code":"S000378132","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":170.00,"discounted_cash":170.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":29.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":10.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":29.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":25.84,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":47.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":42.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":18.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":25.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":18.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":10.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":10.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":28.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":43.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":28.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":18.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":74.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":30.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":74.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":39.10,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":39.10,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":34.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":34.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":54.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":132.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":153.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":144.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":144.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":144.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":27.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":178.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":46.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":76.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":32.47,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":102.00,"methodology":"percent of total billed charges"}]}]},{"description":"CLINIMIX E INJ ","code_information":[{"code":"J3490","type":"HCPCS"},{"code":"P000219903","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":740.85,"discounted_cash":740.85,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":207.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":96.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":185.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":81.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":109.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":81.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":125.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":191.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":125.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":81.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":325.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":134.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":325.97,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":237.07,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":140.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":577.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":666.76,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":370.43,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":629.72,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":629.72,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":629.72,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":370.43,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":370.43,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":118.54,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":777.89,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":203.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":333.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":141.50,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANR CURV SLM6.5X5.2 ","code_information":[{"code":"S000842780","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM 10MM ","code_information":[{"code":"S000842419","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM 11.5MM ","code_information":[{"code":"S000842420","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM 12MM17-001-28 ","code_information":[{"code":"S000685820","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM 4MM 10 002-02 ","code_information":[{"code":"S000718207","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM 6MM 7MM ","code_information":[{"code":"S000842424","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM MNI 7X10MM ","code_information":[{"code":"S000842790","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM OPN 10X13MM ","code_information":[{"code":"S000681271","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM OPN 10X5X11MM ","code_information":[{"code":"S000842405","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1761.00,"discounted_cash":1761.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":112.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":493.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":228.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":440.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":111.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":110.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":563.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1373.58,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1584.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1496.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":880.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1849.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":484.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":792.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":336.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1056.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM PERM 2MM ","code_information":[{"code":"S001483812","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1066.00,"discounted_cash":1066.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":68.22,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":298.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":138.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":266.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":67.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":67.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":341.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":831.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":959.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":533.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":906.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":906.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":906.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":533.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":533.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1119.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":293.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":479.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":203.61,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":639.60,"methodology":"percent of total billed charges"}]}]},{"description":"CLIP ANRSM PERM 5.2MM ","code_information":[{"code":"S000404797","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1741.00,"discounted_cash":1741.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":111.42,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":487.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":226.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":435.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":110.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":109.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":557.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1357.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1566.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":870.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1479.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1479.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1479.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":870.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":870.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1828.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":478.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":783.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":332.53,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1044.60,"methodology":"percent of total billed charges"}]}]},{"description":"D5W 150 ML ","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"P000254602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":807.50,"discounted_cash":807.50,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":226.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":104.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":201.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":119.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":137.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":208.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":137.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":185.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":258.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":629.85,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":726.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":403.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":686.38,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":686.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":686.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":403.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":403.75,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":129.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":847.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":222.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":363.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":154.23,"methodology":"percent of total billed charges"}]}]},{"description":"DALTEPARIN 5000 U INJ ","drug_information":{"unit":"5000","type":"UN"},"code_information":[{"code":"J1645","type":"HCPCS"},{"code":"P000139001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":246.25,"discounted_cash":246.25,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":68.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":32.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":61.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":27.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":36.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":27.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":41.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":63.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":41.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":27.09,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":56.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":78.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":192.07,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":221.63,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":123.13,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":209.31,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":209.31,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":209.31,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":123.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":123.13,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":39.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":258.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":67.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":110.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":47.03,"methodology":"percent of total billed charges"}]}]},{"description":"DAPSONE 25MG TAB ","code_information":[{"code":"P000531302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":22.00,"discounted_cash":22.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":3.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":3.34,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":6.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":5.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":3.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":5.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":9.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":9.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":7.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":17.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":18.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":3.52,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":23.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.20,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.20,"methodology":"percent of total billed charges"}]}]},{"description":"DAUNORUBICIN 20 MG INJ ","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"J9150","type":"HCPCS"},{"code":"P000375901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":869.25,"discounted_cash":869.25,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":243.39,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":113.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":217.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":95.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":128.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":95.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":147.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":224.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":147.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":95.62,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":199.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":278.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":678.01,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":782.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":434.63,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":738.86,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":738.86,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":738.86,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":434.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":434.63,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":139.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":912.71,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":239.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":391.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":166.03,"methodology":"percent of total billed charges"}]}]},{"description":"DEF DRUG ANTIDEP TRI 1-2 ","code_information":[{"code":"80335","type":"CPT"},{"code":"L000029002","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":25.75,"discounted_cash":25.75,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6.44,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":5.15,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8.24,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":20.09,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.18,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.88,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21.89,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21.89,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21.89,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.88,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.88,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":27.04,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.92,"methodology":"percent of total billed charges"}]}]},{"description":"DEFLECTOR DMND 310X4.5MM ","code_information":[{"code":"S007581914","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":7964.00,"discounted_cash":7964.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1385.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":509.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":1385.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":1210.53,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2229.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1035.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1991.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":876.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":1178.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":876.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":503.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":501.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1353.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":2054.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1353.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":876.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":3504.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":1449.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":3504.16,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1831.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1831.72,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1592.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1592.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2548.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1513.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":6211.92,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7167.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3982.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6769.40,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6769.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6769.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3982.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3982.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":1274.24,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":8362.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2190.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3583.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1521.12,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4778.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEMECLOCYCLINE 150MG TAB ","code_information":[{"code":"P000531402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":65.45,"discounted_cash":65.45,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":9.95,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":18.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":9.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":16.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":11.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20.94,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":12.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":51.05,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":58.91,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.73,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55.63,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.73,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.73,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":10.47,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":68.72,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":18.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":29.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12.50,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":39.27,"methodology":"percent of total billed charges"}]}]},{"description":"DERMAGRAFT 1SQCM ","code_information":[{"code":"Q4106","type":"HCPCS"},{"code":"S000698284","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":157.00,"discounted_cash":157.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":43.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":20.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":39.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":17.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":23.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":17.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":26.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":40.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":26.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":17.27,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":36.11,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":50.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":122.46,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":141.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":78.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":133.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":133.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":133.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":78.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":78.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":25.12,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":164.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":43.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":70.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":29.99,"methodology":"percent of total billed charges"}]}]},{"description":"DESMOPRESSIN 1 MCG INJ ","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"P000182301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":75.00,"discounted_cash":75.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":11.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":19.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":67.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":78.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":20.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"}]}]},{"description":"DESMOPRESSIN 1 MCG INJJW ","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"P000182501","type":"CDM"}],"standard_charges":[{"modifiers":"JW","modifiers_description":"Drug amount discarded/not administered to any patient","setting":"outpatient","gross_charge":75.00,"discounted_cash":75.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":11.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":19.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":67.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":78.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":20.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"}]}]},{"description":"DEV CANN DIVDR 12MM ","code_information":[{"code":"S003000856","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1191.00,"discounted_cash":1191.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":207.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":76.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":207.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":181.03,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":333.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":154.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":297.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":131.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":176.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":131.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":75.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":75.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":202.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":307.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":202.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":131.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":524.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":216.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":524.04,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":273.93,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":273.93,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":238.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":238.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":381.12,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":226.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":928.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1071.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":595.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1012.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1012.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1012.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":595.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":595.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":190.56,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1250.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":327.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":535.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":227.48,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":714.60,"methodology":"percent of total billed charges"}]}]},{"description":"DEV CATH BLLN INFL 30ML ","code_information":[{"code":"S001057266","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":419.00,"discounted_cash":419.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":72.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":26.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":72.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":63.69,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":117.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":54.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":104.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":46.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":62.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":46.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":26.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":26.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":71.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":108.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":71.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":46.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":184.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":76.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":184.36,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":96.37,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":96.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":83.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":83.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":134.08,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":79.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":326.82,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":377.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":209.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":356.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":356.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":356.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":209.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":209.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":67.04,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":439.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":115.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":188.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":80.03,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":251.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEV CMPR PRCLUD 24CM30ML ","code_information":[{"code":"S002957038","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":317.00,"discounted_cash":317.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":55.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":20.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":55.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":48.18,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":88.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":41.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":79.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":34.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":46.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":34.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":20.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":19.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":53.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":81.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":53.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":34.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":139.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":57.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":139.48,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":72.91,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":72.91,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":63.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":63.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":101.44,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":60.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":247.26,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":285.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":158.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":269.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":269.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":269.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":158.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":158.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":50.72,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":332.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":87.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":142.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":60.55,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":190.20,"methodology":"percent of total billed charges"}]}]},{"description":"DEV INFL 35ATM/BAR 30ML ","code_information":[{"code":"S000182466","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":427.00,"discounted_cash":427.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":74.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":27.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":74.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":64.90,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":119.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":55.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":106.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":46.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":63.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":46.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":26.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":26.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":72.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":110.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":72.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":46.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":187.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":77.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":187.88,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":98.21,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":98.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":85.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":85.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":136.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":81.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":333.06,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":384.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":213.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":362.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":362.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":362.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":213.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":213.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":68.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":448.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":117.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":192.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":81.56,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":256.20,"methodology":"percent of total billed charges"}]}]},{"description":"DEV SURG SLV OUTR 12MM ","code_information":[{"code":"S000449112","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":892.00,"discounted_cash":892.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":155.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":57.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":155.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":135.58,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":249.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":115.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":223.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":98.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":132.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":98.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":56.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":56.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":151.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":230.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":151.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":98.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":392.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":162.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":392.48,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":205.16,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":205.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":178.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":178.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":285.44,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":169.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":695.76,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":802.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":446.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":758.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":758.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":758.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":446.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":446.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":142.72,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":936.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":245.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":401.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":170.37,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":535.20,"methodology":"percent of total billed charges"}]}]},{"description":"DEV W/DPLOY SUT BTB ","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"S000680220","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2082.00,"discounted_cash":2082.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":582.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":270.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":520.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":666.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1623.96,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1873.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1041.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1769.70,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1769.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1769.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1041.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1041.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2186.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":572.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":936.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":397.66,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE ANC FEM STD 7-8 ","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"S000684628","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2187.00,"discounted_cash":2187.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":612.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":284.31,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":546.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":699.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1705.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1968.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1093.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1858.95,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1858.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1858.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1093.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1093.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2296.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":601.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":984.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":417.72,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE BN BX SZ2 10GA ","code_information":[{"code":"S000622841","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1621.00,"discounted_cash":1621.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":282.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":103.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":282.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":246.39,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":453.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":210.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":405.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":178.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":239.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":178.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":102.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":102.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":275.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":418.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":275.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":178.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":713.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":295.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":713.24,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":372.83,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":372.83,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":324.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":324.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":518.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":307.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1264.38,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1458.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":810.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1377.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1377.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1377.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":810.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":810.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":259.36,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1702.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":445.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":729.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":309.61,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":972.60,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CATH GD 30X106CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000269265","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":37324.00,"discounted_cash":37324.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6494.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6494.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5673.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10450.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4852.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9331.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4105.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5523.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4105.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6345.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":9629.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6345.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4105.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16422.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6792.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16422.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8584.52,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8584.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7464.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7464.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":11943.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7091.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":29112.72,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":33591.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18662.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":31725.40,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":31725.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":31725.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18662.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18662.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":5971.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":39190.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10264.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":16795.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7128.88,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CATH GD 40X135CM ","code_information":[{"code":"C1887","type":"HCPCS"},{"code":"S000269273","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":37763.00,"discounted_cash":37763.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6570.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6570.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5739.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10573.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4909.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9440.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4153.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5588.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4153.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6419.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":9742.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6419.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4153.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16615.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":6872.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":16615.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8685.49,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":8685.49,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7552.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":7552.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12084.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7174.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":29455.14,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":33986.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18881.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32098.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32098.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32098.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18881.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":18881.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6042.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":39651.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10384.83,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":16993.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7212.73,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CLSR 35MM ","code_information":[{"code":"C1760","type":"HCPCS"},{"code":"S007310359","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":79526.00,"discounted_cash":79526.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":22267.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":10338.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":19881.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":25448.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":62030.28,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":71573.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39763.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":67597.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":67597.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":67597.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39763.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39763.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":83502.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":21869.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":35786.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":15189.47,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CLSR CLP INT 40MM ","code_information":[{"code":"S000773647","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":17777.00,"discounted_cash":17777.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1137.73,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4977.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2311.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4444.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1123.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1119.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5688.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":13866.06,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15999.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8888.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15110.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15110.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15110.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8888.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8888.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":18665.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4888.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7999.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3395.41,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10666.20,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CLSR CLP INT 40MM ","code_information":[{"code":"S002087401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":25729.00,"discounted_cash":25729.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1646.66,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7204.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3344.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6432.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1626.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1620.93,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8233.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":20068.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23156.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12864.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21869.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21869.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21869.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12864.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12864.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":27015.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":7075.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11578.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4914.24,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":15437.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CLSR CLP INT 50MM ","code_information":[{"code":"S000773652","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":17777.00,"discounted_cash":17777.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1137.73,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":4977.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":2311.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":4444.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1123.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1119.95,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":5688.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":13866.06,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15999.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8888.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15110.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15110.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15110.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8888.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8888.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":18665.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":4888.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7999.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":3395.41,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10666.20,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CMPR 24CM ","code_information":[{"code":"S000618401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":793.00,"discounted_cash":793.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":137.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":50.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":137.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":120.54,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":222.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":103.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":198.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":87.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":117.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":87.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":50.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":49.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":134.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":204.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":134.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":87.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":348.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":144.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":348.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":182.39,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":182.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":158.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":158.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":253.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":150.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":618.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":713.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":396.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":674.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":674.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":674.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":396.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":396.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":126.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":832.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":218.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":356.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":151.46,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":475.80,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE CMPR RADIAL 24CM ","code_information":[{"code":"S000723654","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":638.00,"discounted_cash":638.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":111.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":40.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":111.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":96.98,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":178.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":82.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":159.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":70.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":94.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":70.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":40.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":40.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":108.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":164.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":108.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":70.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":280.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":116.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":280.72,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":146.74,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":146.74,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":127.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":127.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":204.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":121.22,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":497.64,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":574.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":319.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":542.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":542.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":542.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":319.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":319.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":102.08,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":669.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":175.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":287.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":121.86,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":382.80,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE EMBL 18X4.75MM ","code_information":[{"code":"S000572425","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":64089.00,"discounted_cash":64089.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4101.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":17944.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8331.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16022.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4050.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4037.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20508.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":49989.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":57680.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":67293.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17624.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":28840.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12241.00,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":38453.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE EMBL 20MM 2.75MM ","code_information":[{"code":"S000571919","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":64089.00,"discounted_cash":64089.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4101.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":17944.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8331.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16022.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4050.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4037.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20508.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":49989.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":57680.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":67293.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17624.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":28840.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12241.00,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":38453.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE EMBL 3.25X20MM PL ","code_information":[{"code":"S000572367","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":64089.00,"discounted_cash":64089.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4101.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":17944.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8331.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16022.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4050.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4037.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20508.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":49989.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":57680.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":67293.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17624.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":28840.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12241.00,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":38453.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE EMBL 4.5MM 18MM ","code_information":[{"code":"S007557182","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":67293.00,"discounted_cash":67293.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4306.75,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":18842.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8748.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16823.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4252.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4239.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":21533.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":52488.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":60563.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":33646.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":57199.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":57199.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":57199.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":33646.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":33646.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":70657.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":18505.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":30281.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12852.96,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":40375.80,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE EMBL 5X35MM ","code_information":[{"code":"S000435611","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":64089.00,"discounted_cash":64089.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4101.70,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":17944.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8331.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16022.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4050.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4037.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20508.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":49989.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":57680.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":54475.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32044.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":67293.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17624.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":28840.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12241.00,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":38453.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE ENDO SZ2-0 48IN ","code_information":[{"code":"S000900331","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1009.00,"discounted_cash":1009.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":175.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":64.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":175.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":153.37,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":282.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":131.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":252.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":110.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":149.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":110.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":63.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":63.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":171.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":260.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":171.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":110.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":443.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":183.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":443.96,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":232.07,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":232.07,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":201.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":201.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":322.88,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":191.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":787.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":908.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":504.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":857.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":857.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":857.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":504.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":504.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":161.44,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1059.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":277.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":454.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":192.72,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":605.40,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE FX ACML KNTLS STR ","code_information":[{"code":"C1713","type":"HCPCS"},{"code":"S001315262","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6629.00,"discounted_cash":6629.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1856.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":861.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1657.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2121.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5170.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5966.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3314.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5634.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5634.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5634.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3314.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3314.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":6960.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1822.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2983.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1266.14,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE INFLATION ENCORE ","code_information":[{"code":"S000201440","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":698.00,"discounted_cash":698.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":121.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":44.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":121.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":106.10,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":195.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":90.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":174.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":103.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":44.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":43.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":118.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":180.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":118.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":76.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":307.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":127.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":307.12,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":160.54,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":160.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":139.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":139.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":223.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":132.62,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":544.44,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":628.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":349.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":593.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":593.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":593.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":349.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":349.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":111.68,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":732.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":191.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":314.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":133.32,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":418.80,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE SLD MOTOR DISP ","code_information":[{"code":"S000064382","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":543.00,"discounted_cash":543.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":94.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":34.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":94.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":82.54,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":152.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":70.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":135.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":59.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":80.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":59.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":34.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":34.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":92.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":140.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":92.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":59.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":238.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":98.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":238.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":124.89,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":124.89,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":108.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":108.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":173.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":103.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":423.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":488.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":271.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":461.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":461.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":461.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":271.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":271.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":86.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":570.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":149.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":244.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":103.71,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":325.80,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE STPLR 30MM 30TACK ","code_information":[{"code":"S000906974","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":2735.00,"discounted_cash":2735.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":175.04,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":765.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":355.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":683.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":172.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":172.31,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":875.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2133.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2461.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1367.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2324.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2324.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2324.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1367.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1367.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2871.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":752.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1230.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":522.39,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1641.00,"methodology":"percent of total billed charges"}]}]},{"description":"DEVICE WNDCLS 2-0 ","code_information":[{"code":"S000304563","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":395.00,"discounted_cash":395.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":68.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":25.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":68.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":60.04,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":110.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":51.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":98.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":43.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":58.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":43.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":24.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":24.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":67.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":101.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":67.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":43.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":173.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":71.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":173.80,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":90.85,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":90.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":126.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":75.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":308.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":355.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":197.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":335.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":335.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":335.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":197.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":197.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":63.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":414.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":108.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":177.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":75.45,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":237.00,"methodology":"percent of total billed charges"}]}]},{"description":"DEXAMETH NA PHOS 10 MG ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"P000103801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":25.00,"discounted_cash":25.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":7.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":3.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":6.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":4.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.75,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":8.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":19.50,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":4.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":26.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":6.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.78,"methodology":"percent of total billed charges"}]}]},{"description":"DEXMEDETOMID 200 MCG INJ ","code_information":[{"code":"J3490","type":"HCPCS"},{"code":"P000220701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":47.50,"discounted_cash":47.50,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":13.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":5.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":7.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":5.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":8.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":8.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":5.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":20.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":20.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":15.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":9.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":37.05,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":42.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.75,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":40.38,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":40.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":40.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.75,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":7.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":49.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":13.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":21.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":9.07,"methodology":"percent of total billed charges"}]}]},{"description":"DEXTROSE 10% INJ ","code_information":[{"code":"P000607401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":38.80,"discounted_cash":38.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":2.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":6.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":5.90,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":10.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":5.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":2.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":2.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":10.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":6.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":4.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":7.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":17.07,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":7.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":30.26,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.92,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.40,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32.98,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":32.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.40,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":6.21,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":40.74,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":10.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.41,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":23.28,"methodology":"percent of total billed charges"}]}]},{"description":"DIBUCAINE INHIBITOR ","code_information":[{"code":"82638","type":"CPT"},{"code":"L000106502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4.55,"discounted_cash":4.55,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1.14,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.05,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":0.91,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":0.91,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":0.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3.55,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4.09,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.27,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3.87,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3.87,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3.87,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.27,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.27,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":0.73,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4.78,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":0.87,"methodology":"percent of total billed charges"}]}]},{"description":"DIFFUSING CAPACITY ","code_information":[{"code":"94729","type":"CPT"},{"code":"R000007401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2348.95,"discounted_cash":2348.95,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":408.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":408.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":357.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":657.71,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":305.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":587.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1033.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":427.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":1033.54,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":540.26,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":540.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":469.79,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":469.79,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":751.66,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":446.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1832.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2114.05,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1174.47,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1996.61,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1996.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1996.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1174.47,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1174.47,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":375.83,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2466.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":645.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1057.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":448.65,"methodology":"percent of total billed charges"}]}]},{"description":"DIGOXIN 0.05MG/ML LIQ ","code_information":[{"code":"P000532702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":23.10,"discounted_cash":23.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":1.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":4.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":3.51,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":6.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":5.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":3.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":1.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":1.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":5.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":3.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":2.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":10.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":4.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":10.16,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":7.39,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":18.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.79,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19.64,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11.55,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":3.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":24.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":6.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.41,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.86,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR SEQNTL SPN STRL ","code_information":[{"code":"S000903220","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1385.00,"discounted_cash":1385.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":240.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":88.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":240.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":210.52,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":387.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":180.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":346.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":152.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":204.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":152.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":87.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":87.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":235.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":357.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":235.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":152.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":609.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":252.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":609.40,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":318.55,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":318.55,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":277.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":277.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":443.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":263.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1080.30,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1246.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":692.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1177.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1177.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1177.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":692.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":692.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":221.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":1454.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":380.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":623.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":264.54,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":831.00,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR SURG HDRPH 14FR ","code_information":[{"code":"S000296164","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":1924.00,"discounted_cash":1924.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":334.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":123.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":334.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":292.45,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":538.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":250.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":481.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":284.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":121.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":121.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":327.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":496.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":327.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":846.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":350.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":846.56,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":442.52,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":442.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":384.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":384.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":615.68,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":365.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1500.72,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1731.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":962.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1635.40,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1635.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1635.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":962.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":962.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":307.84,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2020.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":529.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":865.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":367.48,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1154.40,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR VASC 13FR 20CM ","code_information":[{"code":"S000160551","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":117.00,"discounted_cash":117.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":20.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":7.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":20.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":17.78,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":32.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":29.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":17.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":7.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":7.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":19.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":30.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":19.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":51.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":21.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":51.48,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":26.91,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":26.91,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":37.44,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":22.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":91.26,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":105.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":99.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":99.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":99.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":18.72,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":122.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":32.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":52.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":22.35,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":70.20,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR VASC 16FR 20CM ","code_information":[{"code":"S000171125","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":118.00,"discounted_cash":118.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":20.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":7.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":20.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":17.94,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":33.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":29.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":17.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":7.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":7.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":20.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":30.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":20.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":51.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":21.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":51.92,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.14,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":23.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":23.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":37.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":22.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":92.04,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":106.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":100.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":100.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":100.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":18.88,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":123.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":32.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":53.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":22.54,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":70.80,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR VASC 4FR ","code_information":[{"code":"S000205144","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":65.00,"discounted_cash":65.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":4.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":11.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":8.45,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":9.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":4.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":4.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":16.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":11.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":7.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":11.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":28.60,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":20.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":12.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":50.70,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":55.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":68.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":17.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":29.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":39.00,"methodology":"percent of total billed charges"}]}]},{"description":"DILATOR VSSL 10F 038 ","code_information":[{"code":"S000205151","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":139.00,"discounted_cash":139.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":24.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":8.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":24.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":21.13,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":38.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":18.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":34.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":20.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":8.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":8.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":23.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":35.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":23.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":15.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":61.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":25.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":61.16,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":31.97,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":31.97,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":27.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":27.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":44.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":26.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":108.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":125.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":69.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":118.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":118.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":118.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":69.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":69.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":22.24,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":145.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":38.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":62.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":26.55,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":83.40,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ART KN 3-4-5 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000243634","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ART KN 7-10 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000727269","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC 1-2 C-D 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000727228","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC 10-11 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000177147","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC 7-8 12MM LT ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000224839","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 00-0 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000506049","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 00-0 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000243633","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 00-0 19MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000341709","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 00-0 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000243632","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 1-2 19MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000596893","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000146256","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT FEM KN STND SZ7 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002839361","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":29998.00,"discounted_cash":29998.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":8399.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3899.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":7499.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":9599.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":23398.44,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26998.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14999.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":25498.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":25498.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":25498.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":31497.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":8249.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13499.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5729.62,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT FEM SZ4 15X10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000692267","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3794.00,"discounted_cash":3794.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1062.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":493.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":948.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1214.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2959.32,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3414.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1897.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3224.90,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3224.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3224.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1897.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1897.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3983.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1043.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1707.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":724.65,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HIP 22.2MM 36MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000393417","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HUM 6MM 32MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000240141","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4678.00,"discounted_cash":4678.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1309.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":608.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1496.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3648.84,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4210.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4911.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1286.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HUM SHLDR +3X39MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000048085","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3743.00,"discounted_cash":3743.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1048.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":486.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":935.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1197.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2919.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3368.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1871.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3181.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3181.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3181.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1871.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1871.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3930.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1029.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1684.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":714.91,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HUM SHLDR 39MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000039398","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3743.00,"discounted_cash":3743.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1048.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":486.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":935.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1197.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2919.54,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3368.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1871.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3181.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3181.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3181.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1871.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1871.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3930.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1029.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1684.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":714.91,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HUM SHLDR 8X36MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000442324","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4678.00,"discounted_cash":4678.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1309.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":608.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1496.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3648.84,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4210.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4911.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1286.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HUM SZ3/4 42MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007472000","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7859.00,"discounted_cash":7859.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2200.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1021.67,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1964.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2514.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":6130.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7073.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3929.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6680.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6680.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6680.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3929.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3929.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":8251.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2161.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3536.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1501.07,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN BRNG SZ4 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002752759","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN LT SZ7-8 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000144628","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN LT TIB SZ4.5MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002148037","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7017.00,"discounted_cash":7017.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1964.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":912.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1754.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2245.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5473.26,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6315.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3508.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5964.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5964.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5964.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3508.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3508.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7367.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1929.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3157.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1340.25,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN RT 9MM SZ 5-6 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000224926","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN TIB 1.5 15MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001395917","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN TIB SZ3-4 18MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000274963","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT KN X3 SZ3 22MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000570946","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7116.00,"discounted_cash":7116.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1992.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":925.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1779.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2277.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5550.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6404.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7471.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1956.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3202.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1359.16,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT MOD 1.5 OFST 3.6 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000220135","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5380.00,"discounted_cash":5380.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1506.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":699.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1345.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1721.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4196.40,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4842.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2690.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4573.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4573.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4573.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2690.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2690.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":5649.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1479.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2421.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1027.58,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT POST TIB 1 22MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002722430","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT SHLDR +6 36MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000803159","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2339.00,"discounted_cash":2339.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":654.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":304.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":584.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":748.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1824.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1988.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1988.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1988.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2455.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":643.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1052.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":446.75,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TEMP BLADDER CATH ","code_information":[{"code":"H000001902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":453.05,"discounted_cash":453.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":78.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":29.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":78.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":68.86,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":49.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":67.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":49.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":28.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":28.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":77.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":116.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":77.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":49.84,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":144.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":353.38,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":407.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":226.53,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":385.09,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":385.09,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":385.09,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":226.53,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":226.53,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":72.49,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":475.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":124.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":203.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":86.53,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":271.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 1 13IN PST ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000105946","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 1 9MM 3X ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786053","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 1.5 12MM KN T ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002143299","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 1.5 19MM KN ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001390697","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 2 9 KN TRTHN ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000587493","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7116.00,"discounted_cash":7116.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1992.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":925.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1779.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2277.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5550.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6404.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7471.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1956.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3202.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1359.16,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 2.5 12MM KN P ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002090533","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 2.5 19MM KN ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001390284","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 20MM PROX SM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000069169","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3537.00,"discounted_cash":3537.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":459.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":884.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1131.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2758.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3183.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1768.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3006.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3006.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3006.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1768.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1768.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3713.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":972.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1591.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":675.57,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 3 13MM PST ST ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000106178","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 3.5 12MM KN P ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002029214","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 3.5 9MM PST S ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000925558","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 5 20MM KN RP ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000124324","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3196.00,"discounted_cash":3196.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":894.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":415.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":799.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1022.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2492.88,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2876.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1598.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2716.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2716.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2716.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1598.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1598.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3355.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":878.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1438.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":610.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB 6 14MM CRU RE ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000808285","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB ANKL SZ3 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000276914","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":13146.00,"discounted_cash":13146.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":3680.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1708.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3286.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":4206.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":10253.88,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":11831.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6573.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11174.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11174.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":11174.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6573.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6573.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":13803.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":3615.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5915.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2510.89,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB ANKL SZ3 6MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000502309","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9731.00,"discounted_cash":9731.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2724.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1265.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2432.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3113.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7590.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8757.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4865.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8271.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8271.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8271.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4865.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4865.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10217.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2676.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4378.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1858.62,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB ANKL SZ3 8MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000200869","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9731.00,"discounted_cash":9731.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2724.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1265.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2432.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3113.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7590.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8757.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4865.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8271.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8271.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8271.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4865.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4865.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10217.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2676.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4378.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1858.62,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB G KN 6 13MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000729910","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786327","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 13MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786314","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000831875","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7116.00,"discounted_cash":7116.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1992.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":925.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1779.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2277.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5550.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6404.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7471.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1956.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3202.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1359.16,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 2.5X12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002147760","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 20MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000565732","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3537.00,"discounted_cash":3537.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":459.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":884.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1131.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2758.86,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3183.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1768.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3006.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3006.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3006.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1768.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1768.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3713.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":972.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1591.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":675.57,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 4-5 13MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S003166010","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 4.5F/5.5T ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002150970","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4678.00,"discounted_cash":4678.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1309.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":608.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1496.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3648.84,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4210.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4911.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1286.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN 5 8MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002780877","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN BRNG 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002724563","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN BRNG 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002725543","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN LT G 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001508433","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN LT3-4 15MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000224911","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN RT SZ4 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S003166054","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4678.00,"discounted_cash":4678.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1309.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":608.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1496.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3648.84,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4210.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4911.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1286.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN RT SZF 8MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001508467","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SIZE 3 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000693460","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7579.00,"discounted_cash":7579.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2122.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":985.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1894.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2425.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5911.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6821.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7957.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2084.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3410.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1447.59,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SIZE4 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000693507","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7579.00,"discounted_cash":7579.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2122.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":985.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1894.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2425.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5911.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6821.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7957.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2084.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3410.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1447.59,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ 5 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S008210873","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ1-2 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007645508","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ1.5 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001396053","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ1.5 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002152362","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002769477","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 13MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001389381","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786309","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002727340","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7116.00,"discounted_cash":7116.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1992.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":925.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1779.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2277.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5550.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6404.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7471.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1956.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3202.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1359.16,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 17MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001396459","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 19MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001388810","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 8MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000746256","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786054","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2.5 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002146550","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2.5 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002149475","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ2.5 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001393115","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3 12MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002719735","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000332352","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786315","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3 7MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000332323","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3 8.0MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000110350","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2339.00,"discounted_cash":2339.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":654.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":304.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":584.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":748.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1824.42,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1988.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1988.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1988.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2455.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":643.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1052.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":446.75,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3.5 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001388502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ3F/2T ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001395918","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4678.00,"discounted_cash":4678.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1309.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":608.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1169.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1496.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3648.84,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4210.20,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3976.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2339.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4911.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1286.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2105.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":893.50,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ4 14MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000771814","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ4 19MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002230257","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7579.00,"discounted_cash":7579.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2122.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":985.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1894.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2425.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5911.62,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6821.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6442.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3789.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7957.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2084.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3410.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1447.59,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ4 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002722373","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002151662","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5 13MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001394345","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5 14MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000057275","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3877.00,"discounted_cash":3877.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1085.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":504.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":969.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1240.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3024.06,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3489.30,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1938.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3295.45,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3295.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3295.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1938.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1938.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4070.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1066.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1744.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":740.51,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5 14MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001212731","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5 5MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000199867","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5-6 15MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000291934","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5-6 15MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007645569","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ5-6 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007621388","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ6 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002722930","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7116.00,"discounted_cash":7116.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1992.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":925.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1779.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":2277.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":5550.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6404.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6048.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3558.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":7471.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1956.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3202.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1359.16,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ6 6MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007598491","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ6-7 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000788452","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ7 14MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002514245","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN SZ7-8 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000370926","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB KN8-11EF 14MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001354084","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB L 7-9 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002839304","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10526.00,"discounted_cash":10526.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2947.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1368.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2631.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3368.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":8210.28,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9473.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5263.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8947.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8947.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8947.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5263.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5263.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":11052.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2894.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4736.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2010.47,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB PS BR79/83X10 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000723383","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB PS SZ3.5 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001691249","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB SZ3 19MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001390640","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB SZ5-6 RT 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007621389","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB SZ6 7MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001212735","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB SZ6 8MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000785887","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB SZ6 8MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001212736","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB SZ7-8 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S007645506","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB UC SZ4 11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001212721","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB X3 2 11MM TRI ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000844482","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB1 KN TRLT 10MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S002150383","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB1.5 KN TRL11MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001394321","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TIB2 11IN PST STB ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000106126","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TRTHN TIB G-509 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000729904","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4445.00,"discounted_cash":4445.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1244.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":577.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1111.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1422.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":3467.10,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4000.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3778.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2222.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":4667.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1222.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2000.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":849.00,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT TRTHN TIB G-525 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000786330","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10031.00,"discounted_cash":10031.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":2808.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1304.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2507.75,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":3209.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":7824.18,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9027.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5015.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8526.35,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8526.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8526.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5015.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5015.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":10532.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":2758.53,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4513.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1915.92,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT XLPE 22/40MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S003112247","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSR SZ5-6 EF GREEN 28 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000427937","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6020.00,"discounted_cash":6020.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1685.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":782.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1505.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1926.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4695.60,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5418.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3010.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5117.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5117.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5117.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3010.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3010.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":6321.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1655.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2709.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1149.82,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT ARTC KN 10-12 16MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000953840","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3509.00,"discounted_cash":3509.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":982.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":456.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":877.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1122.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2737.02,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3158.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2982.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1754.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3684.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":964.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":670.22,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT HUM SHLDR 36X+3MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000310081","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3766.00,"discounted_cash":3766.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1054.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":489.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":941.50,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1205.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2937.48,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3389.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1883.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3201.10,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3201.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3201.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1883.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1883.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3954.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1035.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1694.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":719.31,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT KN SZ5-6 9MM ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000964179","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3041.00,"discounted_cash":3041.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":851.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":395.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":760.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":973.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2371.98,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2736.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2584.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1520.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3193.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":836.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1368.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":580.83,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB 2 PST STB LOGI ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000605628","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB 3 PST STB LGC ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000317756","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB 4 PST STB LGC ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000303457","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB KN 6481-3-313 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000143357","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3572.00,"discounted_cash":3572.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1000.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":464.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":893.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1143.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2786.16,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3214.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1786.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3036.20,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3036.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3036.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1786.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1786.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":3750.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":982.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1607.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":682.25,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB LGIC SZ1 ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000183644","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB SZ2 10MM VIT-E ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S001212710","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB2.5 11MM PSTSTB ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000355141","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INSRT TIB2.5 13MM KNPOST ","code_information":[{"code":"C1776","type":"HCPCS"},{"code":"S000925556","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2573.00,"discounted_cash":2573.00,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":720.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":334.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":643.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":823.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":2006.94,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2315.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2187.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1286.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":2701.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":707.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1157.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":491.44,"methodology":"percent of total billed charges"}]}]},{"description":"INST PASSR SUT DISP MD ","code_information":[{"code":"S007608316","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15000.00,"maximum":15000.00,"gross_charge":5194.00,"discounted_cash":5194.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":903.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":6.40,"standard_charge_algorithm":"Reimbursement will be 6.4% of billable gross charges.","estimated_amount":332.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":903.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":789.49,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15000.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1454.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":675.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1298.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":571.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":768.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":571.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":6.32,"standard_charge_algorithm":"Reimbursement will be 6.32% of billable gross charges.","estimated_amount":328.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.30,"standard_charge_algorithm":"Reimbursement will be 6.3% of billable gross charges.","estimated_amount":327.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":882.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":1340.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":882.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":571.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2285.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":945.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2285.36,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1194.62,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1194.62,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1038.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1038.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1662.08,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":986.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4051.32,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4674.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2597.00,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4414.90,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4414.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4414.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2597.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2597.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":831.04,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":5453.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1428.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2337.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":992.05,"methodology":"percent of total billed charges"},{"payer_name":"WellPath ","plan_name":"GVT","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3116.40,"methodology":"percent of total billed charges"}]}]},{"description":"INSULIN 20 U INJ ","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"P000147206","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5.35,"discounted_cash":5.35,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":1.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":0.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":0.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":1.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":0.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":0.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":2.35,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.23,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.23,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1.07,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":1.07,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":1.71,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":4.17,"methodology":"percent of total billed charges"},{"payer_name":"NovaNet","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4.81,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.67,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4.55,"methodology":"percent of total billed charges"},{"payer_name":"PPO Next","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.67,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.67,"methodology":"percent of total billed charges"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges not to exceed $3900.","estimated_amount":0.86,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_percentage":105.00,"standard_charge_algorithm":"Reimbursement will be 105% of billable gross charges.","estimated_amount":5.62,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":27.50,"standard_charge_algorithm":"Reimbursement will be 27.5% of billable gross charges.","estimated_amount":1.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1.02,"methodology":"percent of total billed charges"}]}]},{"description":"INSULIN 5 U INJ ","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"P000147301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1.35,"discounted_cash":1.35,"payers_information":[{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":28.00,"standard_charge_algorithm":"Reimbursement will be 28% of billable gross charges.","estimated_amount":0.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":0.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":14.80,"standard_charge_algorithm":"Reimbursement will be 14.8% of billable gross charges.","estimated_amount":0.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":25.80,"standard_charge_algorithm":"Reimbursement will be 25.8% of billable gross charges.","estimated_amount":0.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":0.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_percentage":18.20,"standard_charge_algorithm":"Reimbursement will be 18.2% of billable gross charges.","estimated_amount":0.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":0.31,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions Healthcare","plan_name":"COMM","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":0.31,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":0.27,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":0.27,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":0.43,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":0.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":1.05,"methodology":"percent of total billed char