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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":28585.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":38895.64,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":28585.50,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":13420.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":13420.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":39643.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":72044.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":39643.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":28585.50,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":13287.95,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10847.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13155.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":14616.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":23447.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":37452.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13686.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14218.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13553.71,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13686.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":14085.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":16609.94,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":13420.83,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":13420.83,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":13420.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12484.64,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Sunshine State","plan_name":"MCR","standard_charge_dollar":15746.22,"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":13287.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12703.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":57350.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":67629.89,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":54644.95,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":54644.95,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":54644.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":53734.18,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":64113.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":54103.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":51723.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $6447 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":54103.91,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":53021.83,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and -DQB1 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":11313.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11421.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10990.39,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11098.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":10882.64,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":11744.63,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10563.70,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10451.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":11421.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":13468.61,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10882.64,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10882.64,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10882.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9944.89,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12768.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10774.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10300.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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","code_information":[{"code":"L2006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36570.46,"maximum":42979.71,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37701.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":40340.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":38832.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":41471.65,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39963.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":38455.53,"methodology":"fee schedule"},{"payer_name":"BCBS 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12080.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16437.36,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12080.28,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8203.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8203.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16753.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":30446.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16753.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12080.28,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":8122.26,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6311.73,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8041.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":8934.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":13642.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21791.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8365.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8690.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":13709.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13840.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14437.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19644.97,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14437.64,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":13187.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":13187.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20022.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":36387.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20022.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14437.64,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":13056.73,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10644.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12926.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":14362.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":23008.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":36751.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13448.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13970.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13317.86,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13448.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":13187.30,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":14231.84,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":12800.82,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12665.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":13840.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":16320.91,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":13187.30,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":13187.30,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":13187.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12250.97,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":15472.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":13056.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12482.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $6447 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":13056.73,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":12795.60,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) ","code_information":[{"code":"81371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366.64,"maximum":505.65,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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","code_information":[{"code":"81379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303.98,"maximum":419.23,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10682.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10212.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25278.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":34395.33,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25278.10,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9460.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9460.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":35056.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":63709.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":35056.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25278.10,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":9366.60,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7404.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9272.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10303.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":16004.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":25563.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9647.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10022.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":9928.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":11708.25,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9460.27,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9460.27,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9460.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8521.64,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11099.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":9366.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8954.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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","code_information":[{"code":"E0260","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":71.67,"maximum":84.23,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":73.89,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":79.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":76.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":81.28,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":78.32,"methodology":"fee 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","code_information":[{"code":"L5460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":620.14,"maximum":728.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":639.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":684.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":658.50,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":703.25,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":677.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":652.11,"methodology":"fee schedule"},{"payer_name":"BCBS 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10074.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":11880.61,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9599.53,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9599.53,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9599.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8660.99,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11262.81,"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":9504.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9086.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7666.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10431.40,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7666.33,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":7882.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":7882.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10632.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19321.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10632.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7666.33,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":7804.45,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6032.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":7726.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":8584.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":13039.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":20827.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8038.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8350.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":7882.50,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":8506.85,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7651.48,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":7570.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":7804.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7461.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":14878.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14224.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10059.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":11862.74,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9585.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9585.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9585.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8646.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11245.88,"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. 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16357.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22256.98,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16357.28,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9684.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9684.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22685.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41225.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22685.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16357.28,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":9588.56,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7599.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9492.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10547.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":16425.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26236.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9876.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10259.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10205.69,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10305.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10605.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12506.98,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10105.64,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10105.64,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10105.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9167.41,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11856.61,"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. 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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":40700.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":55379.58,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":40700.01,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":17912.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":17912.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":56444.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":102577.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":56444.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":40700.01,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":17734.77,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14752.71,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17557.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":19508.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":31887.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":50934.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":18266.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18976.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18089.47,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18266.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":17734.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16954.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":10503.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10603.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7998.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10883.93,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7998.90,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10103.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10103.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11093.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20159.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11093.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7998.90,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":10003.06,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7963.30,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9903.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11003.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":17212.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":27493.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10303.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10703.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10203.12,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10303.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":10103.09,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":10903.34,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9807.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9702.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10603.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12503.82,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10103.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10103.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10103.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9164.86,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11853.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10003.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9562.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":10044.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10139.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18209.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24777.48,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18209.67,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":25254.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":45894.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25254.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18209.67,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":9565.86,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7579.39,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9470.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10522.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":16382.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26168.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9852.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10235.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9757.18,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9852.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10139.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":11957.33,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8723.02,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11335.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":9565.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9144.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":15066.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":9565.86,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9374.54,"methodology":"fee schedule"}]}]},{"description":"Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot ","code_information":[{"code":"L5150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3992.61,"maximum":4692.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4116.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":4404.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4239.57,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4527.70,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4363.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4198.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4198.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4692.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":4527.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4404.22,"methodology":"fee 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charges"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":283.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":343.54,"methodology":"fee 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":10836.91,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10940.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":3974.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":1827.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":3648.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":26170.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10424.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10424.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36294.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":65958.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36294.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":26170.67,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":10320.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10217.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11352.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":17815.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":28457.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10630.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11043.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10527.29,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10630.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":10424.08,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":11249.75,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10118.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10011.24,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10940.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12901.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10424.08,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10424.08,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10424.08,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12230.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10320.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2299.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9866.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":1718.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $345427.00, reimbursement will be $6447 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":10320.87,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10114.45,"methodology":"fee schedule"}]}]},{"description":"Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not ","code_information":[{"code":"G2250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.41,"maximum":13.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":13.32,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":12.11,"methodology":"fee schedule"}]}]},{"description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory s ","code_information":[{"code":"98976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44.61,"maximum":50.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":49.07,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":45.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":45.50,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":48.62,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":45.50,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":44.61,"methodology":"fee schedule"}]}]},{"description":"Replace leather cuff kafo, proximal thigh ","code_information":[{"code":"L4100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":113.89,"maximum":133.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":117.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":125.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":120.93,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":129.15,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":124.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":119.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":119.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":129.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":125.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":129.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":117.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":125.63,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":127.98,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":129.15,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":123.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":113.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":117.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":123.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":119.76,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":117.41,"methodology":"fee schedule"}]}]},{"description":"Replace metal bands kafo-afo, calf or distal thigh ","code_information":[{"code":"L4090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":100.97,"maximum":118.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":104.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":111.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":107.21,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":114.50,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":110.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":106.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":106.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":118.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":114.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":111.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":114.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":104.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":111.38,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":113.46,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":114.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":109.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":100.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":104.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":109.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":106.17,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":104.09,"methodology":"fee schedule"}]}]},{"description":"Replace quadrilateral socket brim, custom fitted ","code_information":[{"code":"L4030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":538.81,"maximum":633.24,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":555.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":594.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":572.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":611.02,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":588.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":566.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":566.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":633.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":611.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":594.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":611.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":555.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":594.35,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":605.46,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":611.02,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":583.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":538.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":555.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":583.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":566.58,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":555.47,"methodology":"fee schedule"}]}]},{"description":"Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient ","code_information":[{"code":"A4630","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":8.25,"maximum":9.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":9.36,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8.51,"methodology":"fee schedule"}]}]},{"description":"Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each ","code_information":[{"code":"K0602","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":8.14,"maximum":9.56,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":9.23,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8.39,"methodology":"fee schedule"}]}]},{"description":"Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each ","code_information":[{"code":"A4235","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":0.97,"maximum":1.14,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1.10,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":1.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1.10,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":1.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":1.00,"methodology":"fee schedule"}]}]},{"description":"Replacement cushions for jaw motion rehabilitation system, pkg. of 6 ","code_information":[{"code":"E1701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13.33,"maximum":15.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":14.98,"methodology":"fee 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":29556.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":40216.62,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":29556.33,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":53234.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":53234.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":40990.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":74491.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":40990.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":29556.33,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":52707.39,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":45463.04,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":52180.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":57978.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":98266.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":156962.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":54288.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56396.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":55869.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":65884.24,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":53234.46,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":53234.46,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":53234.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":52322.83,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":62458.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":52707.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":50388.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":18606.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18783.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":26652.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36265.33,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":26652.41,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":17897.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":17897.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36962.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":67172.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36962.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":26652.41,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":17720.48,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14740.16,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17543.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":19492.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":31860.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":50890.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":18252.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18960.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18074.89,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18252.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":17897.68,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":19315.32,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17373.16,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17188.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":18783.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":22150.60,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":17897.68,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":17897.68,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":17897.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16964.26,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":20998.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":17720.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16940.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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","plan_name":"MCR","standard_charge_dollar":373.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":399.59,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":384.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":410.80,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":395.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":380.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":380.92,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":425.73,"methodology":"fee 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":15932.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16084.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":23131.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":31473.88,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":23131.04,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":15325.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":15325.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":32079.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58297.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":32079.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":23131.04,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":15173.79,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12503.85,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15022.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":16691.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":27026.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":43169.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":15629.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16235.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15477.27,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15629.00,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":15325.53,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":16539.43,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":14876.38,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14718.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":16084.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":18967.24,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":15325.53,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":15325.53,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":15325.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14390.52,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":17980.94,"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":15173.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14506.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $6447 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":15173.79,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14870.31,"methodology":"fee schedule"}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC ","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":66689.49,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":22931.56,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":23619.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":24078.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24307.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":23131.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":31473.88,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":23131.04,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":32079.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58297.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":32079.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":23131.04,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":22931.56,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":19316.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":22702.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":25224.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":41750.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":66689.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":23619.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24536.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":23390.19,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23619.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":24995.40,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":22482.10,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":22243.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":24307.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":28664.45,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":23160.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22230.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":27173.90,"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. 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HealthSpring","plan_name":"MCR","standard_charge_dollar":107.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":110.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":100.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":107.32,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":109.33,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":110.33,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":105.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":97.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":100.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":105.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":102.31,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":100.30,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable ","code_information":[{"code":"L2300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":292.44,"maximum":343.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":301.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":322.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":310.52,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":331.63,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":319.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":307.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":307.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":343.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":331.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":322.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":331.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":301.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":322.58,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":328.61,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":331.63,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":316.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":292.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":301.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":316.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":307.51,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":301.48,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, above knee, leather socket ","code_information":[{"code":"L5642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":704.41,"maximum":827.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":726.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":777.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":747.99,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":798.82,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":769.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":740.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":740.72,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":827.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":798.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":777.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":798.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":726.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":777.03,"methodology":"fee 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","code_information":[{"code":"962430","type":"CDM"},{"code":"L5629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":361.32,"maximum":424.64,"gross_charge":1358.18,"discounted_cash":1358.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":372.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":383.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":409.74,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":394.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":379.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":379.94,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":424.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":409.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":409.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":372.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of 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","code_information":[{"code":"L5684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":54.73,"maximum":64.32,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":60.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":58.11,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":62.06,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":59.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":64.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":60.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":60.37,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":61.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":62.06,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":54.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":56.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":59.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":57.55,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":56.42,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, knee disarticulation, expandable wall socket ","code_information":[{"code":"L5653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":661.70,"maximum":777.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":682.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":729.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":702.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":750.39,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":723.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":695.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":695.81,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":777.67,"methodology":"fee 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schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":661.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":682.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":716.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":695.81,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":682.17,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only ","code_information":[{"code":"L2320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":219.58,"maximum":258.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":226.37,"methodology":"fee schedule"},{"payer_name":"Align Senior 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schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":237.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":230.90,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":226.37,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, pelvic control, hip joint, heavy duty, each ","code_information":[{"code":"907079","type":"CDM"},{"code":"L2620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":285.34,"maximum":335.34,"gross_charge":1191.94,"discounted_cash":1191.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":314.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":302.98,"methodology":"fee 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Health","plan_name":"MCR","standard_charge_dollar":323.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":314.75,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":320.63,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":323.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":308.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":285.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":308.87,"methodology":"fee 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for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":702.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":675.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":675.58,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":755.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":728.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":708.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":728.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":662.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":708.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":721.94,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":728.56,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":695.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":642.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":662.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":695.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":675.58,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":662.33,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, split flat caliper stirrups and plate attachment ","code_information":[{"code":"L2230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":81.89,"maximum":96.24,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":84.42,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":90.33,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":86.95,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":92.86,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":89.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":96.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":90.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":84.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":90.33,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":92.02,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":92.86,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":88.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":81.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":84.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":88.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":84.42,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, symes type, expandable wall socket ","code_information":[{"code":"L5630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":510.26,"maximum":599.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":526.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":562.86,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":541.82,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":578.64,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":557.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":536.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":536.56,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":599.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":578.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":562.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":578.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":526.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":562.86,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":573.38,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":578.64,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":552.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":510.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":526.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":552.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":536.56,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":526.04,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, test socket, above knee ","code_information":[{"code":"L5624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":413.35,"maximum":485.79,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":426.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":455.96,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":438.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":468.74,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":451.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":434.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":434.65,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":485.79,"methodology":"fee 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schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":413.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":426.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":447.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":434.65,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":426.13,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model ","code_information":[{"code":"L2540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":451.19,"maximum":530.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":465.14,"methodology":"fee schedule"},{"payer_name":"Align Senior 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Care","plan_name":"MCR","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":2.94,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":2.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":2.75,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":2.70,"methodology":"fee schedule"}]}]},{"description":"Segmental pneumatic appliance for use with pneumatic compressor, trunk ","code_information":[{"code":"E0656","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":76.48,"maximum":89.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":81.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":86.73,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":83.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":80.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":80.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":89.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":86.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":84.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":86.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":10083.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10179.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":30648.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":16130.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":28140.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":17954.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22369.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":17954.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9698.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9698.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22826.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":49866.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22826.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":17954.00,"methodology":"case rate"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":9602.85,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7611.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9506.83,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10563.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":39732.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":53569.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9890.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10275.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9794.91,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9890.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":9698.88,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":10467.11,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9414.64,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9314.77,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10179.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12003.57,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9698.88,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9698.88,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9698.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8760.41,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11379.38,"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":9602.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9180.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":71405.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":97160.08,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":71405.68,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":47145.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":47145.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":99028.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":179965.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":99028.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":71405.68,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":46679.07,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":40169.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":46212.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":51346.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":86824.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":138685.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":48079.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49946.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":29556.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":40216.62,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":29556.33,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":26507.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":26507.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":40990.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":74491.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":40990.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":29556.33,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":26245.03,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22225.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":25982.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":28869.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":48039.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76735.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":27032.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28082.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10743.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12668.82,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10236.41,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10236.41,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10236.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9298.27,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12010.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":8775.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8859.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11740.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15974.85,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11740.37,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8441.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8441.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16282.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":29589.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16282.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11740.37,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":8357.68,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6518.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8274.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9193.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":14089.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":22505.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8608.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8942.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8524.83,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8608.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":8859.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":10447.10,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":8441.25,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":8441.25,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":8441.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7502.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":9903.85,"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":8357.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7989.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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","plan_name":"MCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":125.54,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":120.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":129.06,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":124.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":133.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":129.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":125.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":129.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":125.54,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":127.89,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":129.06,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":123.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":113.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":123.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":117.33,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulation to aid bone healing; noninvasive (nonoperative) ","code_information":[{"code":"20974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80.71,"maximum":2702.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Align Senior 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10613.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12516.44,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10113.28,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10113.28,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10113.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9175.06,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11865.58,"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":10013.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $8618 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9572.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":12500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $6447 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":10013.15,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9812.89,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 27.85 & M < 38.75 ","code_information":[{"code":"138","type":"RC"},{"code":"D2003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19548.99,"maximum":26879.86,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":24436.24,"methodology":"fee schedule"},{"payer_name":"Alignment 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