{"hospital_name": "ERIE COUNTY MEDICAL CENTER CORPORATION", "last_updated_on": "2026-08-25", "version": "3.0.0", "pid": "2876714025", "rid": "16196", "location_name": ["ECMC Hospital"], "hospital_address": ["462 Grider St, Buffalo, NY 14215"], "type_2_npi": ["1437197985"], "license_information": {"license_number": "1401005H", "state": "NY"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Anthony Markiewicz"}, "standard_charge_information": [{"description": "\"\"Y SET\"\" TUBING", "code_information": [{"code": "A4719", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.0, "maximum": 4.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "0.9% SODIUM CHLORIDE PRES.FREE", "drug_information": {"unit": 10.0, "type": "ML"}, "code_information": [{"code": "5210400678", "type": "CDM"}, {"code": "00409488710", "type": "NDC"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 2.64, "setting": "both", "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 10.0, "maximum": 70.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 57.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 70.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 24.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 21.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 BOD TEMP >=35.5", "code_information": [{"code": "G9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 BODYTEMP >=35.5CW/IN 30MIN", "code_information": [{"code": "4559F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4206", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.27, "maximum": 0.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.0, "maximum": 28.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 MED VISIT IN 24MO", "code_information": [{"code": "G9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 OR NO CT SINUS W/IN 90D DX", "code_information": [{"code": "G9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "10-20 STAB PHLEBECTOMY 1 EXTRM", "code_information": [{"code": "37765", "type": "CPT"}, {"code": "6420377536", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 9853.58, "gross_charge": 7603.23, "discounted_cash": 1389.53, "estimated_discounted_cash": 17615.4, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4059.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9853.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 3057.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 6811.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 6811.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5518.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 3057.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4020.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3027.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 6811.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3481.27, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4236.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3027.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4419.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2531.88, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2768.07, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3322.23, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2768.07, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 6969.24, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 4941.37, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2768.07, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 5721.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 7469.8, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9853.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 6811.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 3027.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4335.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 6811.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6842.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 3941.43, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 3027.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 3027.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 3941.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "100 INSULIN SYRINGES", "code_information": [{"code": "S8490", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.0, "maximum": 37.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data 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"fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 41.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 34.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 28.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17667 IRIS RETRACTOR 611.65", "code_information": [{"code": "6400189550", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 37.75, "setting": "both", "billing_class": "facility"}]}, {"description": "18 FR COUNCIL CATHETER", "code_information": [{"code": "4535609470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "setting": "both", "billing_class": "facility"}]}, {"description": "18 GA. 20CM NEEDLE", "code_information": [{"code": "4535607230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "setting": "both", "billing_class": "facility"}]}, {"description": "18100 HEMOLOK CLIP LARGE", "code_information": [{"code": "6400702530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.23, "setting": "both", "billing_class": "facility"}]}, {"description": "19586 MAYFIELD PIN DISP", "code_information": [{"code": "6400701370", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 75.1, "setting": "both", "billing_class": "facility"}]}, {"description": "1DOSE MENIG VAC BTWN 11 & 13", "code_information": [{"code": "G9414", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 145.01, "maximum": 3604.43, "discounted_cash": 3671.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 145.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 2500.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2961.87, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 3604.43, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2967.1, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1699.75, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}, {"code": "99223", "type": "CDM"}], "standard_charges": [{"gross_charge": 198.0, "setting": "both", "billing_class": "professional"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 2137.0, "maximum": 4252.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2137.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2137.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3545.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4252.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2989.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2491.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3194.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2921.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 98.81, "maximum": 3604.43, "discounted_cash": 3671.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 98.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 2500.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2961.87, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 3604.43, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2967.1, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1699.75, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}, {"code": "99222", "type": "CDM"}], "standard_charges": [{"gross_charge": 149.0, "setting": "both", "billing_class": "professional"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 2137.0, "maximum": 4252.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2137.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2137.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3545.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4252.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2989.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2491.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3194.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2921.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 73.27, "maximum": 3604.43, "discounted_cash": 3671.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 73.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 2500.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "additional_payer_notes": "Obs rate", "standard_charge_dollar": 1900.0, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2961.87, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 3604.43, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2967.1, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Flat Rate | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1699.75, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}, {"code": "99221", "type": "CDM"}], "standard_charges": [{"gross_charge": 95.0, "setting": "both", "billing_class": "professional"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 2137.0, "maximum": 4252.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2137.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2137.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3545.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4252.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2989.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2491.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3194.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2921.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 120.5, "maximum": 560.3, "discounted_cash": 509.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 120.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 463.25, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 560.3, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 458.67, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 274.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 179.01, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 210.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 265.36, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 223.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 210.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 93.97, "maximum": 435.77, "discounted_cash": 401.23, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 93.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 360.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 435.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 356.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 213.11, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 130.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 154.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 194.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 163.36, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 118.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 154.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 65.04, "maximum": 301.79, "discounted_cash": 281.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 65.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 249.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 301.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 147.59, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 78.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 116.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 98.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 71.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 47.77, "maximum": 522.23, "discounted_cash": 472.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 163.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 48.24, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 107.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 107.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 48.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 107.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 431.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 522.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 427.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 255.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 107.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 107.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 47.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 96.12, "maximum": 515.37, "discounted_cash": 481.21, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 130.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 177.53, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 129.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 426.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 515.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 252.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 317.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 139.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 96.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 113.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 142.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 119.86, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 97.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 113.08, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 30.93, "maximum": 197.58, "discounted_cash": 199.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 163.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 197.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 161.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 96.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 42.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 49.46, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 62.32, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 52.43, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 42.47, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 49.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4207", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.15, "maximum": 0.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.0, "maximum": 56.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.4, "maximum": 74.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 74.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.0, "maximum": 56.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.4, "maximum": 74.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 74.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.6, "maximum": 41.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.6, "maximum": 41.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.4, "maximum": 42.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 42.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.4, "maximum": 42.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 42.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTI-HYPRTNSV AGENTS TKN", "code_information": [{"code": "4145F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTIPSY SCHIZ", "code_information": [{"code": "G0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ BENZO SEIZ", "code_information": [{"code": "G0033", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "20 FR. 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billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.67, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.67, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.99, "maximum": 123.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 86.21, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 37.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 50.29, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 36.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 102.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 123.97, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 101.49, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 35.91, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 35.91, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 35.91, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 35.91, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 35.92, "methodology": "fee 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{"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "21-HYDROXYLASE ANTIBODIES", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "6600000095", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.8, "maximum": 348.31, "gross_charge": 387.02, "discounted_cash": 57.54, "estimated_discounted_cash": 372.47, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 25.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "22 FT. 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"methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 108.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 108.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D CEPHALOMETRIC IMAGE", "code_information": [{"code": "D0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.18, "maximum": 271.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 111.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 108.25, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 241.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 241.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 152.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 108.25, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 110.8, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 241.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 271.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 241.15, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 119.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 241.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 108.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 107.18, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 108.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D ORAL/FACIAL PHOTO IMAGE", "code_information": [{"code": "D0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.96, "maximum": 271.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 111.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 152.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 110.8, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 271.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 119.49, "methodology": "fee 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{"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 108.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 409.34, "maximum": 2446.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1007.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2446.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 1369.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 998.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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{"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1012.24, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 419.31, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1223.44, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1376.3, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2446.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential 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"plan_name": "Medicare", "standard_charge_dollar": 978.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 978.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 409.34, "maximum": 2446.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1007.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2446.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 1369.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 998.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 419.31, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 503.17, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", 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"Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1376.3, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2446.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1076.42, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 978.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 978.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 189.54, "maximum": 1088.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 448.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1088.73, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 609.69, "methodology": "fee 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189.54, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 227.45, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 189.54, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 609.58, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 457.56, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: 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{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 435.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3011.08, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3664.32, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1753.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3844.46, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2202.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential 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"methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1753.75, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1753.75, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4423.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2ND CLOSR SURG WND/DEHS COMP", "code_information": [{"code": "13160", "type": "CPT"}, {"code": "8710313160", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 1753.75, "maximum": 11058.93, "gross_charge": 2835.89, "discounted_cash": 3710.0, "estimated_discounted_cash": 11821.08, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4556.28, 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found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 141.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 135.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 135.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 135.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 135.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4208", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 COMP FOOT EXAM COMPLETED", "code_information": [{"code": "G9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 212.46, "maximum": 4319.48, "discounted_cash": 770.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 592.61, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1779.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4319.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 214.59, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 478.04, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 478.04, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 2418.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 214.59, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 1762.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 478.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 719.76, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 870.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 712.65, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 425.74, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 726.19, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 871.43, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 726.19, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2335.45, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1753.05, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 726.19, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2118.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2383.54, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4319.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 478.04, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1900.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 478.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 1727.79, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 482.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 567.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 714.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 601.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 212.46, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 489.51, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 567.23, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1727.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN DIRECT", "code_information": [{"code": "D0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.66, "maximum": 69.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 17.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D DENTAL SCAN INDIRECT", "code_information": [{"code": "D0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.66, "maximum": 69.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 17.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 26.95, "maximum": 921.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 29.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 70.65, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 85.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 69.95, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 41.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 27.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 34.1, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 26.95, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN DIRECT", "code_information": [{"code": "D0803", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.27, "maximum": 69.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D FACIAL SCAN INDIRECT", "code_information": [{"code": "D0804", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.27, "maximum": 69.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D PRINT OF 3D SURFACE SCAN", "code_information": [{"code": "D0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.96, "maximum": 69.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 31.27, "methodology": "fee 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"plan_name": "Government Programs", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 30.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 21.25, "maximum": 43.45, "discounted_cash": 55.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 36.36, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 27.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 43.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 24.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 29.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 37.03, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 31.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 24.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 29.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}, {"code": "76376", "type": "CDM"}], "standard_charges": [{"gross_charge": 15.0, "setting": "both", "billing_class": "professional"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76377", "type": "CPT"}], "standard_charges": [{"minimum": 53.88, "maximum": 115.88, "discounted_cash": 129.31, "estimated_discounted_cash": 640.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 87.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 91.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 110.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 90.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 53.88, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_percentage": 90.0, "possible_amount": 558.54, "count": "1 through 10", "median_amount": 558.54, "methodology": "percent of total billed charges", "10th_percentile": 558.54, "90th_percentile": 558.54}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 78.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 91.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 115.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 97.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 77.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 91.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "76377", "type": "CDM"}], "standard_charges": [{"gross_charge": 57.0, "setting": "both", "billing_class": "professional"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"minimum": 29.2, "maximum": 29.2, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 29.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3D W/ POST PROCESS", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "6510990746", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 664.05, "estimated_discounted_cash": 640.65, "setting": "both", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}], "standard_charges": [{"minimum": 128.29, "maximum": 744.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 306.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 744.6, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 416.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 303.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 128.29, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 153.95, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 128.29, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 412.59, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 309.7, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 128.29, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 374.31, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 421.08, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 744.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 327.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 297.84, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 297.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy", "code_information": [{"code": "G0566", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.62, "maximum": 401.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 165.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 401.55, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 224.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 163.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 176.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 160.62, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 160.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D-CRT/IMRT RECEIVED", "code_information": [{"code": 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"MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3d anatomical segmentation imaging for preoperative planning, data preparation and transmission, obtained from previous diagnostic computed tomographic or magnetic resonance examination of the same anatomy", "code_information": [{"code": "C8001", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.62, "maximum": 401.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": 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billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 176.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 160.62, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 160.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "4 EM CORE SESSIONS", "code_information": [{"code": "G9874", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.0, "maximum": 84.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and 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{"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "4 FACTOR PCC (HUMAN) - KCENTRA", "drug_information": {"unit": 1.0, "type": "UN"}, "code_information": [{"code": "5210202816", "type": "CDM"}, {"code": "63833038602A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 12.49, "setting": "both", "billing_class": "facility"}]}, {"description": "40-75Y W/TYPE 1/2 W/LDL-C RS", "code_information": [{"code": "G9676", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 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"percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 86.93, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 193.65, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 193.65, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 86.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 86.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 193.65, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", 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"standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 11.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", 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"methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.98, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 13.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 11.71, "methodology": "fee 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"plan_name": "Medicare", "standard_charge_dollar": 7.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE IN LAC RINGERS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7121", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.66, "maximum": 9.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 7.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 8.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 8.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 8.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 8.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 8.46, "methodology": "fee 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"plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5% WL MAINTND FROM BSLINE WT", "code_information": [{"code": "G9888", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.4, "maximum": 6.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5%DEXTROSE/0.45%SALINE1000ML", "code_information": [{"code": "S5013", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.27, "maximum": 11.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5+ CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4209", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "5-FLUOROURACIL 500 MG/10 ML VI", "drug_information": {"unit": 10.0, "type": "ML"}, "code_information": [{"code": "J9190", "type": "HCPCS"}, {"code": "5210100021", "type": "CDM"}, {"code": "63323011710A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.91, "maximum": 54.99, "gross_charge": 61.1, "estimated_discounted_cash": 23.73, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2.21, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2.21, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1.95, "methodology": "fee schedule"}, {"payer_name": "Highmark 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"methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 1.91, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 54.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 2.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "6 X 24 STENT", "code_information": [{"code": "4535621660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "6400944133", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400944133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory 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"Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "6400944240", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400944240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48479.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO EVC RTNOPTHY", "code_information": [{"code": "2024F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 FLD RTA PHOTO W/O RTNOPTHY", "code_information": [{"code": "2025F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "7 PANEL DRUG SCREEN", "code_information": [{"code": "5313700120", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "setting": "both", "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.0, "maximum": 140.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "9 PANEL DRUG SCREEN", "code_information": [{"code": "5313999893", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "<50% TOTAL PT OUTPT RA ENCTS", "code_information": [{"code": "M1008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "<6YR NEW ONSET HD ACHE", "code_information": [{"code": "G2193", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">55 YRS TEMP HD ACHE", "code_information": [{"code": "G2192", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED NOT ORD", "code_information": [{"code": "G9368", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">= 2 SAME HI-RSK MED ORD", "code_information": [{"code": "G9367", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME HI-RSK MED W/O DIAG", "code_information": [{"code": "M1209", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=2 SAME MEDS TBL4 NOT ORD", "code_information": [{"code": "M1210", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=50% TOTAL PT OUTPT RA ENCT", "code_information": [{"code": "M1007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": ">=86Y NO HX COLO CA/RSN SCOP", "code_information": [{"code": "G9659", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified", "code_information": [{"code": "M1379", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D HALFWAY HOUSE, PER DIEM", "code_information": [{"code": "H2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 342.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER DIEM", "code_information": [{"code": "H2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 406.29, "maximum": 406.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 406.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER DIEM", "code_information": [{"code": "H2036", "type": "HCPCS"}, {"code": "912", "type": "RC"}], "standard_charges": [{"minimum": 780.0, "maximum": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER DIEM", "code_information": [{"code": "H2036", "type": "HCPCS"}, {"code": "913", "type": "RC"}], "standard_charges": [{"minimum": 780.0, "maximum": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER HOUR", "code_information": [{"code": "H2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.93, "maximum": 323.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 59.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AAA RELIANT STENT BALLOON", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "6400990160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 99.47, "maximum": 1018.07, "gross_charge": 1131.19, "estimated_discounted_cash": 444.91, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 952.46, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 99.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 483.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 483.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 483.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 483.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 735.27, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 735.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1018.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AAC NON-ELECTRONIC BOARD", "code_information": [{"code": "E1902", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.32, "maximum": 138.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 138.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AB ADAPTER B NS LEAD 8 CHAN", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "6400940198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.56, "maximum": 12119.85, "gross_charge": 13466.5, "estimated_discounted_cash": 4719.13, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 11338.79, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 28.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8753.22, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8753.22, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 8753.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12119.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AB ADPTR 8 CHNL NEUROSTM M TYP", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "6400943377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.56, "maximum": 12119.85, "gross_charge": 13466.5, "estimated_discounted_cash": 4719.13, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 11338.79, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 28.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8753.22, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8753.22, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 8753.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12119.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 5750.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AB ALLERGAN INSP BR IMP 770CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "6400943701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.32, "maximum": 4848.21, "gross_charge": 5386.9, "estimated_discounted_cash": 4416.4, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4535.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 402.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health 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"plan_name": "Medicare", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AB ALLODERM MEDIUM 16X20CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "6400942512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 33.75, "maximum": 3362.36, "gross_charge": 122.62, "estimated_discounted_cash": 11389.56, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AB ALLODERM RESTORE LGMED/SQCM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "6400942907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 33.75, "maximum": 3362.36, "gross_charge": 122.62, "estimated_discounted_cash": 11389.56, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee 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{"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AB ANCR SLM TIP LD50X22CMSML2", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "6400943002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 582.6, "maximum": 12119.85, "gross_charge": 13466.5, "estimated_discounted_cash": 9294.33, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 11338.79, "methodology": "fee schedule"}, {"payer_name": 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Premium", "standard_charge_dollar": 50.68, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 44.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.73, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 59.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 45.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 45.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 44.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 44.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 36.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 44.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 44.77, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 53.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABATACEPT/MALTOSE 250 MG INJ", "drug_information": {"unit": 250.0, "type": "ME"}, "code_information": [{"code": "5210920064", "type": "CDM"}, {"code": "00003218713A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2407.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABCIXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 1294.26, "maximum": 4800.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1294.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2154.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4800.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4800.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2154.7, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2133.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4800.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 1375.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 1375.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service 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"methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4800.07, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2133.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2133.36, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2133.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD IMAG W/US, CT OR MRI", "code_information": [{"code": "G9455", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 544.45, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 386.03, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 216.25, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 446.99, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 583.55, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 769.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1428.52, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 761.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1132.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLAT PERC NRVE PLEXUS W/IMAG", "code_information": [{"code": "442T", "type": "CPT"}, {"code": "6510000401", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 362.43, "maximum": 27386.88, "gross_charge": 13142.71, "discounted_cash": 670.46, "setting": "both", 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{"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"minimum": 767.86, 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"Essential QHP", "standard_charge_dollar": 4823.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2143.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4823.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 1617.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 1956.8, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", 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{"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 1807.06, "maximum": 4571.33, "discounted_cash": 4165.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1807.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3779.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4571.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3742.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2235.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No 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"standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2143.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2324.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1388.72, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4823.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2143.94, "methodology": "fee 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"methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": 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"payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 853.76, "maximum": 4823.87, "discounted_cash": 1999.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 863.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4823.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4823.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2165.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2143.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4823.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 1805.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2183.69, "methodology": 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"standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 5120.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 6192.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5069.61, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 3028.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 9677.27, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1355.81, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8778.69, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 5029.05, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 15371.37, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 18448.7, "methodology": "case rate"}, {"payer_name": 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{"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 54717.95, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3050.57, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1355.81, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 24075.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3050.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 21887.18, 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 7952.11, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 9677.27, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8778.69, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 5029.05, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 24340.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2619.0, 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9736.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 872.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1026.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1293.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1088.54, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 999.57, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1026.92, 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"standard_charge_dollar": 1632.55, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1360.23, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 3424.69, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 2428.19, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1360.23, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 2811.68, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", 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"plan_name": "Medicare", "standard_charge_dollar": 1936.82, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 3212.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 3212.5, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1936.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "estimated_discounted_cash": 4403.85, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, 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"standard_charge_dollar": 3538.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2213.94, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2694.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1572.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2815.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1612.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1360.23, "methodology": "case 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{"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 17166.38, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22644.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3050.57, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1355.81, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 9963.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2406.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3050.57, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", 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16543.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 3435.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 12053.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 7654.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2753.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3330.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2726.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1628.94, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 8298.96, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 9960.41, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 8298.96, "methodology": "case rate"}, {"payer_name": "Independent 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"standard_charge_dollar": 7654.09, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 12998.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 7654.09, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 11816.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1641.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1380.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 3401.82, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 11816.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": 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"plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 2437.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1675.94, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1675.94, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 2437.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTN LIVER TUMR PERQ RADFREQ", "code_information": [{"code": "47382", "type": "CPT"}, {"code": "6510047382", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 20870.85, "gross_charge": 23189.84, "discounted_cash": 6167.0, "estimated_discounted_cash": 22279.58, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 7772.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18866.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2928.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 6523.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 6523.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 10565.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2928.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 7697.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2899.49, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 6523.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 5019.25, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 6108.15, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2899.49, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5479.07, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 3138.78, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 5299.93, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 6360.97, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 5299.93, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 13343.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 9461.08, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 5299.93, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 10955.3, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 14302.18, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18866.33, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 6523.86, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2899.49, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 8301.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 6523.86, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20870.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 7546.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2899.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2899.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 7546.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 206.12, "maximum": 948.54, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 659.59, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 283.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 384.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 280.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 784.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 233.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 233.61, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO RH BLOOD TYPING DOCD", "code_information": [{"code": "3293F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of 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"standard_charge_dollar": 1429.61, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 635.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "Independent 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{"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1429.61, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 635.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 635.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1429.61, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 635.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total 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"HMOPOSAlign", "standard_charge_dollar": 1614.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 1952.76, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1598.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 954.99, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2159.74, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 2159.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "360", "type": 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"Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": 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{"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": 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"standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 267.15, "maximum": 2159.74, "discounted_cash": 671.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 391.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 950.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 969.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 2159.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 2159.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 532.55, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 969.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", 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"additional_payer_notes": "CF $64.20", "standard_charge_dollar": 267.15, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 320.63, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 267.15, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 672.61, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 476.89, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 267.15, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 380.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 959.89, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 380.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", 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"methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case 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"Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10969.55, "maximum": 208561.6, "estimated_discounted_cash": 11369.12, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 208561.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 11298.64, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 15357.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 11188.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10969.55, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 10969.55, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 11365.55, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 11188.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 10969.55, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 10969.64, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 10969.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9203.83, "maximum": 174990.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 174990.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9479.94, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 12885.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 9387.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9203.83, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 9203.83, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 9536.09, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 9387.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 9203.83, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 9203.91, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 9203.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOVE KNEE SURGICAL STOCKING", "code_information": [{"code": "A4490", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 175.89, "maximum": 954.65, "discounted_cash": 954.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 257.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 626.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 410.57, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 350.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 410.57, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 255.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 784.47, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 954.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 847.57, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 485.55, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 175.89, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 211.1, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 175.89, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 442.85, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 313.99, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 175.89, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 363.58, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 474.65, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 626.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 275.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 250.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 250.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential 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"standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 15.55, "maximum": 954.65, "discounted_cash": 954.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": 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"additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 784.47, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 954.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 847.57, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 485.55, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 914.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 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"methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "367", 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"standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE NOSE", "code_information": [{"code": "30000", "type": "CPT"}, {"code": "5975991811", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 169.13, "maximum": 3120.0, "gross_charge": 1394.77, "discounted_cash": 363.36, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 304.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 170.82, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 380.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 380.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 413.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 170.82, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 301.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 169.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 380.54, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 784.47, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 954.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 169.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 847.57, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 485.55, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 207.64, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 249.21, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 207.64, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 522.79, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 370.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 207.64, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 429.21, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 560.33, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.15, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 380.54, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 169.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 380.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1255.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 295.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 169.13, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 169.13, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 295.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}], "standard_charges": [{"minimum": 103.94, "maximum": 1007.37, "discounted_cash": 198.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 132.31, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 139.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1007.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1007.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1007.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 175.73, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 212.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 173.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 103.94, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1007.37, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1007.37, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 111.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 131.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 165.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 139.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 447.72, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 115.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 131.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "75989", "type": "CDM"}], "standard_charges": [{"gross_charge": 77.0, "setting": "both", "billing_class": "professional"}]}, {"description": "ABSCESS IMAGING LTD AREA", "code_information": [{"code": "78805", "type": "CPT"}, {"code": "78805", "type": "CDM"}], "standard_charges": [{"gross_charge": 39.0, "setting": "both", "billing_class": "professional"}]}, {"description": "ABSORBIC ACID 500MG/50ML VIAL", "drug_information": {"unit": 1.0, "type": "ML"}, "code_information": [{"code": "5210880804", "type": "CDM"}, {"code": "67157010150A", "type": "NDC"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1378.19, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORP DRG <= 16 SUC PUMP", "code_information": [{"code": "K0744", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.53, "maximum": 19.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >16<=48 SUC PUMP", "code_information": [{"code": "K0745", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORP DRG >48 SUC PUMP", "code_information": [{"code": "K0746", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABSORPT DRG > 48 SQ IN W/BDR", "code_information": [{"code": "A6256", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.0, "maximum": 4.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT CROWN PORC TO TITANIUM", "code_information": [{"code": "D6097", "type": "HCPCS"}], "standard_charges": [{"minimum": 233.98, "maximum": 233.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 233.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT LOCATOR EV 3.6 X 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400995079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48479.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUT LOCATOR EV 4.2 X 5MM", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "6400994872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 3814.06, "gross_charge": 4237.85, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3568.26, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2754.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2754.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2754.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3814.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1809.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUT RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6195", "type": "HCPCS"}], "standard_charges": [{"minimum": 275.13, "maximum": 275.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 275.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT CROWN TITANIUM", "code_information": [{"code": "D6094", "type": "HCPCS"}], "standard_charges": [{"minimum": 293.76, "maximum": 293.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 293.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT RETAINER TITANI", "code_information": [{"code": "D6194", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.41, "maximum": 338.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 338.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT ALL CERAMIC BRIDGE", "code_information": [{"code": "5880067401", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 986.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT ALL CERAMIC BRIDGE", "code_information": [{"code": "5970067401", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 986.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT ALL CERAMIC BRIDGE", "code_information": [{"code": "D6740", "type": "HCPCS"}, {"code": "8715006740", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"minimum": 290.52, "maximum": 1096.39, "gross_charge": 986.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 830.21, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 290.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 640.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 492.16, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1096.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1096.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 492.16, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1096.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 640.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1096.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1096.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 887.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 487.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT ALL CERAMIC BRIDGE SP", "code_information": [{"code": "8715440144", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 986.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT MULTIB EV SM 1.5MM17D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400943210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48479.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT MULTIB EV SM 2.5MM17D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400943211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48479.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT PLCMNT SEMI PRECISION", "code_information": [{"code": "5880006191", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT PLCMNT SEMI PRECISION", "code_information": [{"code": "5970006191", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT PLCMNT SEMI PRECISION", "code_information": [{"code": "8715006191", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED CROWN", "code_information": [{"code": "D6058", "type": "HCPCS"}], "standard_charges": [{"minimum": 356.02, "maximum": 356.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 356.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6059", "type": "HCPCS"}], "standard_charges": [{"minimum": 348.33, "maximum": 348.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 348.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6060", "type": "HCPCS"}], "standard_charges": [{"minimum": 323.52, "maximum": 323.52, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 323.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6061", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.46, "maximum": 330.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 330.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6062", "type": "HCPCS"}], "standard_charges": [{"minimum": 333.96, "maximum": 333.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 333.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6063", "type": "HCPCS"}], "standard_charges": [{"minimum": 305.4, "maximum": 305.4, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 305.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6064", "type": "HCPCS"}], "standard_charges": [{"minimum": 320.79, "maximum": 320.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 320.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6068", "type": "HCPCS"}], "standard_charges": [{"minimum": 325.5, "maximum": 325.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6069", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.06, "maximum": 347.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 347.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6070", "type": "HCPCS"}, {"code": "8715006070", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"minimum": 318.57, "maximum": 1621.8, "gross_charge": 1802.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1517.28, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 318.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1171.3, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1171.3, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1171.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6071", "type": "HCPCS"}], "standard_charges": [{"minimum": 330.46, "maximum": 330.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 330.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6072", "type": "HCPCS"}], "standard_charges": [{"minimum": 344.83, "maximum": 344.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 344.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6073", "type": "HCPCS"}], "standard_charges": [{"minimum": 302.92, "maximum": 302.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": 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"methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6074", "type": "HCPCS"}], "standard_charges": [{"minimum": 310.86, "maximum": 310.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 310.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No 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{"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1707.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1707.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1707.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1707.81, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], 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"plan_name": "Essential Aliessa", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 72.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No 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"methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 240.3, "maximum": 995.87, "discounted_cash": 920.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 320.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 540.67, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 240.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 540.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 240.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 240.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "38794", "type": "CDM"}], "standard_charges": [{"gross_charge": 370.0, "setting": "both", "billing_class": "professional"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": 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"plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.63, "maximum": 241.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 62.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 108.44, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 241.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 241.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 108.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 107.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 241.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 107.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health 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"Univera", "plan_name": "Medicaid", "standard_charge_dollar": 107.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCUFILL BONE SUBSTITUTE 5CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "6400993135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1494.39, "maximum": 43509.78, "gross_charge": 48344.2, "estimated_discounted_cash": 6782.42, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 40705.81, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2178.09, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31423.73, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": 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3362.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43509.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 20642.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCUPROBE MYCOBACTERIA SPECIES", "code_information": [{"code": "87550", "type": "CPT"}, {"code": "6605087550", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.99, "maximum": 94.69, "gross_charge": 105.22, "discounted_cash": 85.43, "setting": 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"Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 20.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 69.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 33.85, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": 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"estimated_discounted_cash": 51.82, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1109.33, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 82.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 562.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 562.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 562.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 562.57, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1185.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACD SCREW FUSION 14-37MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400943446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 317.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 35012.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48479.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACE ARB ARNI", "code_information": [{"code": "G2092", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE COLLAGN MEMBRN RCM6 20X30M", "code_information": [{"code": "6400943667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ACE-I/ARB RX", "code_information": [{"code": "M1200", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB NOT RX'D; DOC REAS", "code_information": [{"code": "G8474", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THERAPY RXD/TAKEN", "code_information": [{"code": "4010F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY FOR MOS/>", "code_information": [{"code": "4210F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY NOT RX'D", "code_information": [{"code": "G8475", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY RX'D", "code_information": [{"code": "G8473", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACELL CYTAL BURN MATRX 938SQCM", "code_information": [{"code": "Q4166", "type": "HCPCS"}, {"code": "6400993628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19.97, "maximum": 3362.38, "gross_charge": 91.04, "estimated_discounted_cash": 4126.83, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 76.65, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 81.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACELL CYTAL MATRIX 10X15/SQCM", "code_information": [{"code": "Q4166", "type": "HCPCS"}, {"code": "6400994596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19.97, "maximum": 3362.38, "gross_charge": 91.04, "estimated_discounted_cash": 4126.83, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 76.65, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", 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"plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39321.0, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 39321.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 54444.47, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": 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"fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 52.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 63.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 31.06, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee 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{"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACHR MODULATING AB", "code_information": [{"code": "86043", "type": "CPT"}, {"code": "6600986267", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.23, "maximum": 256.89, "gross_charge": 285.44, "estimated_discounted_cash": 272.99, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 28.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 34.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 41.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child 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"plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACID CONC SOL PER GALLON", "code_information": [{"code": "A4709", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.0, "maximum": 5.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total 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"standard_charge_dollar": 281.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 821.66, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 924.32, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1164.53, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1426.69, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 634.08, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 512.39, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 114.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 16.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Univera", 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"methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 83.54, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 49.91, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 83.04, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 99.65, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 83.04, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 267.06, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 200.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 83.04, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 242.29, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 272.56, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 176.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 160.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 39.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 33.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 160.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"minimum": 13.57, "maximum": 229.58, "discounted_cash": 47.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.55, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 103.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 65.27, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 103.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 47.55, "methodology": "fee 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{"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 50.29, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 20.83, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 60.78, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.37, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 46.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 16.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 46.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS-NO DSCNMKR DOCD", "code_information": [{"code": "1124F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACP DISCUSS/DSCN MKR DOCD", "code_information": [{"code": "1123F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 24.47, "maximum": 115.64, "discounted_cash": 138.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 78.29, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 45.67, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 33.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 93.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 112.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.16, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per 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"Per Unit", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 115.64, "methodology": "fee 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{"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 41.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 51.39, "maximum": 300.13, "discounted_cash": 370.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 208.7, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 89.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 121.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 88.7, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 248.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 300.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.7, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 146.78, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 88.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 104.52, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 131.7, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 110.79, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 91.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 104.52, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 51.39, "maximum": 270.11, 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"methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 79.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 223.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 270.11, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 221.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 132.1, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 58.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 58.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 58.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 66.52, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 94.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 118.52, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 99.7, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 94.06, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 78.26, "methodology": "fee 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 368.95, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 180.43, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 31.53, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", 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"Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 28.13, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 33.09, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 41.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 35.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 31.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 33.09, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 23.51, "maximum": 85.71, "discounted_cash": 83.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 32.23, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 32.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 85.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 70.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23.51, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 27.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 29.32, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 26.27, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special 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"plan_name": "Access", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 45.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 38.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 33.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 36.02, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", 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"standard_charge_dollar": 32.23, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 32.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 78.47, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", 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"880", "type": "MS-DRG"}, {"code": "144", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 10714.69, "estimated_discounted_cash": 63860.5, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Mental Health rate", "standard_charge_dollar": 1606.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Mental Health rate", "standard_charge_dollar": 10714.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "Psychiatric rate", "standard_charge_dollar": 1372.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}, {"code": "154", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 10714.69, "estimated_discounted_cash": 63860.5, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Mental Health rate", "standard_charge_dollar": 1606.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Mental Health rate", "standard_charge_dollar": 10714.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "Psychiatric rate", "standard_charge_dollar": 1372.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}, {"code": "204", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 2600.0, "estimated_discounted_cash": 63860.5, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "per diem"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "Psychiatric rate", "standard_charge_dollar": 1372.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [{"code": "289", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18673.5, "maximum": 355035.2, "estimated_discounted_cash": 19813.06, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 355035.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19233.71, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 26142.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 19046.97, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18673.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 18673.5, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 19347.61, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 19046.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 18673.5, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 18673.66, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 18673.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [{"code": "288", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29605.86, "maximum": 562889.6, "estimated_discounted_cash": 59057.64, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 562889.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30494.04, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 41448.2, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 30197.98, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29605.86, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 29605.86, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 30674.63, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 30197.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 29605.86, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 29606.1, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 29605.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [{"code": "290", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10170.93, "maximum": 193377.6, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 193377.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10476.06, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 14239.3, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 10374.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10170.93, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 10170.93, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 10538.1, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 10374.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 10170.93, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 10171.01, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 10170.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CHRONIC OBSTRUCT", "code_information": [{"code": "G9681", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE CONGESTIVE HEART", "code_information": [{"code": "G9680", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE PNEUMONIA", "code_information": [{"code": "G9679", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE SKIN INFECTION", "code_information": [{"code": "G9682", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE CARE URINARY TRACT INF", "code_information": [{"code": "G9684", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE FLUID/ELECTRO DISORDER", "code_information": [{"code": "G9683", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}], "standard_charges": [{"minimum": 213.27, "maximum": 2119.14, "discounted_cash": 902.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 593.02, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 514.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1247.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 951.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 698.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 951.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 509.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 842.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 1018.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 834.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 498.31, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 213.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 255.92, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 213.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 685.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 514.83, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 213.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 622.25, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 700.0, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1247.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 548.93, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 499.03, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 316.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 372.68, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 469.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 395.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 330.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 372.68, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 499.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}, {"code": "78278", "type": "CDM"}], "standard_charges": [{"gross_charge": 62.0, "setting": "both", "billing_class": "professional"}]}, {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22818.67, "maximum": 433846.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 433846.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 23503.23, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 31946.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 23275.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22818.67, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 22818.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 23642.42, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 23275.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 22818.67, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 22818.86, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 22818.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"minimum": 60059.56, "maximum": 1141899.2, "estimated_discounted_cash": 94623.41, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1141899.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 61861.35, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 84083.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 61260.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 60059.56, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 60059.56, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 62227.71, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 61260.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 60059.56, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 60060.05, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 60059.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES", "code_information": [{"code": "850", "type": "MS-DRG"}], "standard_charges": [{"minimum": 94735.02, "maximum": 1801176.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1801176.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 97577.07, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 132629.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 96629.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94735.02, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 94735.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 98154.95, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 96629.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 94735.02, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 94735.8, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 94735.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "836", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13341.34, "maximum": 253656.0, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 253656.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13741.58, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 18677.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 13608.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13341.34, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 13341.34, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 13822.96, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 13608.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 13341.34, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 13341.45, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 13341.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12726.51, "maximum": 241966.4, "estimated_discounted_cash": 43405.81, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 241966.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13108.31, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 17817.11, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 12981.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12726.51, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 12726.51, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 13185.94, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 12981.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12726.51, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 12726.62, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 12726.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8596.66, "maximum": 163446.4, "estimated_discounted_cash": 21942.16, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 163446.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8854.56, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 12035.32, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 8768.59, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8596.66, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 8596.66, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 8907.0, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 8768.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 8596.66, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 8596.73, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 8596.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [{"code": "281", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10054.96, "maximum": 191172.8, "estimated_discounted_cash": 31411.18, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 191172.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10356.61, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 14076.94, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 10256.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10054.96, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 10054.96, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 10417.94, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 10256.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 10054.96, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 10055.05, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 10054.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [{"code": "280", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17548.87, "maximum": 333652.8, "estimated_discounted_cash": 41665.59, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 333652.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 18075.34, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 24568.42, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 17899.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17548.87, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 17548.87, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 18182.38, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 17899.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 17548.87, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 17549.01, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 17548.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [{"code": "282", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7910.72, "maximum": 150404.8, "estimated_discounted_cash": 27080.49, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 150404.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8148.04, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 11075.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 8068.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7910.72, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 7910.72, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 8196.3, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 8068.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 7910.72, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 7910.79, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 7910.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [{"code": "284", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7572.67, "maximum": 143977.6, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 143977.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 7799.85, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 10601.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 7724.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7572.67, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 7572.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 7846.04, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 7724.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 7572.67, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 7572.74, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 7572.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [{"code": "283", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21669.97, "maximum": 412006.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 412006.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 22320.07, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 30337.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 22103.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21669.97, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 21669.97, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 22452.26, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 22103.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 21669.97, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 21670.15, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 21669.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6551.97, "maximum": 124571.2, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 124571.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 6748.53, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 9172.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 6683.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6551.97, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 6551.97, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 6788.5, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 6683.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 6551.97, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 6552.03, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 6551.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE NURSING FACILITY CARE", "code_information": [{"code": "G9685", "type": "HCPCS"}], "standard_charges": [{"minimum": 145.01, "maximum": 675.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 145.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 558.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 675.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 552.67, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 330.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE PVD", "code_information": [{"code": "M1337", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 286.88, "maximum": 4040.23, "discounted_cash": 815.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 542.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1664.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4040.23, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 435.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 2262.53, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 435.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 1648.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 743.53, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 899.3, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 736.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 439.8, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 692.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 831.44, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 692.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2228.3, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1672.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 692.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2021.59, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2274.18, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4040.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1777.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 1616.09, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 286.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 337.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 425.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 431.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 295.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 337.5, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1616.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VITREOUS HEMORRHAGE", "code_information": [{"code": "M1333", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR 1000 MG/20 ML", "drug_information": {"unit": 20.0, "type": "ML"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "5210084841", "type": "CDM"}, {"code": "63323032524A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.04, "maximum": 30.6, "gross_charge": 34.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR 200 MG CAPSULE", "drug_information": {"unit": 200.0, "type": "ME"}, "code_information": [{"code": "5210084274", "type": "CDM"}, {"code": "61442011405A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 299.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYCLOVIR 200 MG/5 ML ORAL SUS", "code_information": [{"code": "5210082674", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 24.09, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYCLOVIR 200MG/5ML ORAL SUSP", "drug_information": {"unit": 1.0, "type": "ML"}, "code_information": [{"code": "5210083862", "type": "CDM"}, {"code": "31722068147A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 83.88, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYCLOVIR 400MG TAB", "drug_information": {"unit": 400.0, "type": "ME"}, "code_information": [{"code": "5210080115", "type": "CDM"}, {"code": "50268006115A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.94, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYCLOVIR 500 MG VIAL", "drug_information": {"unit": 10.0, "type": "ML"}, "code_information": [{"code": "J0133", "type": "HCPCS"}, {"code": "5210081239", "type": "CDM"}, {"code": "55150015410A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.04, "maximum": 30.6, "gross_charge": 34.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 28.62, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR 800 MG TABLET", "drug_information": {"unit": 800.0, "type": "ME"}, "code_information": [{"code": "5210082336", "type": "CDM"}, {"code": "82804001235A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.54, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 12.37, "maximum": 56.92, "discounted_cash": 59.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 16.98, 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15.81, "maximum": 538.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.93, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 241.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 65.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 241.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 47.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 18.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 50.85, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 38.17, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 46.13, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 51.89, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.93, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 51.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 4719.13, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPT/EXT, PACING/NEURO LEAD", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 4719.13, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 33.81, "maximum": 317.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 130.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 177.53, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 129.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Per Visit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 106.38, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Per Visit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 128.66, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Per Visit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 108.77, "methodology": "other"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Per Visit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 64.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 317.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 139.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 33.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD 30 MINS COUNSEL", "code_information": [{"code": "G2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.29, "maximum": 61.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD CLA SP TO EXIST PARTDEN SP", "code_information": [{"code": "8715440114", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD CLASP TO EXIST PARTIAL DEN", "code_information": [{"code": "5880000173", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD CLASP TO EXIST PARTIAL DEN", "code_information": [{"code": "5970000173", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD CLASP TO EXIST PARTIAL DEN", "code_information": [{"code": "8715000173", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD CLASP TO PARTIAL DENTURE", "code_information": [{"code": "D5660", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.48, "maximum": 480.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 96.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD METAL SUB TO ACRYLC DENT", "code_information": [{"code": "D5876", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.53, "maximum": 480.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 59.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD MTL WEIGHT TO DENTURE SP", "code_information": [{"code": "8715440210", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD MTL WEIGHT TO FULL DENTURE", "code_information": [{"code": "8715005876", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD PROC CONSTRUCT NEW CROWN", "code_information": [{"code": "D2971", "type": "HCPCS"}], "standard_charges": [{"minimum": 151.83, "maximum": 2017.5, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2017.5, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 341.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 341.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 823.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 341.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 566.76, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 680.22, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 566.76, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 1426.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 1011.74, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 566.76, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 1171.52, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 1529.43, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2017.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 341.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 887.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 341.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 807.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 151.83, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 807.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADD TOOTH EXIST PARTIAL DENT", "code_information": [{"code": "5880000172", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD TOOTH EXIST PARTIAL DENT", "code_information": [{"code": "5970000172", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD TOOTH EXIST PARTIAL DENT", "code_information": [{"code": "8715000172", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD TOOTH EXIST PARTL DENT SP", "code_information": [{"code": "8715440113", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADD TOOTH TO PARTIAL DENTURE", "code_information": [{"code": "D5650", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.76, "maximum": 480.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 61.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 215.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 480.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 213.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 47.04, "maximum": 823.52, "discounted_cash": 92.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 208.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 507.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 369.67, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 823.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 823.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 283.99, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 369.67, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 366.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 823.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 79.53, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 96.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 366.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.74, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 47.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 142.46, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 170.98, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 142.46, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 358.68, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 254.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 142.46, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 294.48, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 384.44, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 507.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 823.52, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 366.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 223.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 823.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 202.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 366.01, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 366.01, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 202.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADDL SUPL MATRL&STAF TM PHE", "code_information": [{"code": "99072", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA DETECTED SCREENING", "code_information": [{"code": "3775F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOMA NOT DETECT SCREENING", "code_information": [{"code": "3776F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADENOS DEAM PERIT (ADA PERT)", "code_information": [{"code": "84311", "type": "CPT"}, {"code": "6600084311", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.08, "maximum": 322.41, "gross_charge": 358.24, "discounted_cash": 29.78, "estimated_discounted_cash": 353.55, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 19.44, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 27.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.88, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per 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{"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 322.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE 90 MG/30 ML VIAL", "drug_information": {"unit": 30.0, "type": "ML"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "5210921785", "type": "CDM"}, {"code": "23155025832A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.52, "maximum": 120.69, "gross_charge": 134.1, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 112.91, "methodology": "fee schedule"}, {"payer_name": 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"fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 21.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 8.11, "maximum": 44.42, "discounted_cash": 41.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 30.89, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 36.73, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 44.42, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.94, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.94, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.94, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.94, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 15.47, "methodology": "fee 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"standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 26.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 32.95, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 27.72, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 26.15, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 41.5, "maximum": 93.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.91, "methodology": 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"standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 41.5, "maximum": 93.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 93.37, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHERE TX ASSESS AT LST ANN", "code_information": [{"code": "G8851", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"minimum": 784.44, "maximum": 12896.0, "discounted_cash": 4265.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 12896.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 784.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2201.29, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4903.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4903.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2201.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2179.49, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4903.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3481.27, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4236.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2179.49, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4419.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2531.88, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4903.86, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2179.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4903.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2179.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2179.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.46, "maximum": 3.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 3.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESION BARRIER", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIVE BANDAGE, FIRST-AID", "code_information": [{"code": "A6413", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.35, "maximum": 0.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADIT MDD DYS REM 12 MNTHS", "code_information": [{"code": "G9509", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJ TIS TRNFR TRNK 10SQCM/<", "code_information": [{"code": "14000", "type": "CPT"}, {"code": "8710314000", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 1808.82, "maximum": 6438.9, "gross_charge": 3131.04, "discounted_cash": 3710.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2652.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 3605.78, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 2627.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3011.08, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3664.32, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3844.46, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2202.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 2170.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 4554.11, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 3228.98, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 3738.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 4881.2, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 2833.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2817.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJ TISS TRANS FACE DEF <=10CM", "code_information": [{"code": "14060", "type": "CPT"}, {"code": "5975992069", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1808.82, "maximum": 6438.9, "gross_charge": 3661.21, "discounted_cash": 2042.33, "estimated_discounted_cash": 6087.66, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2652.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 3605.78, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 2627.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3481.27, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4236.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4419.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2531.88, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 2170.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 4554.11, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 3228.98, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 3738.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 4881.2, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 2833.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3295.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJ TISS TXFER F/N/G/H <10SQCM", "code_information": [{"code": "14040", "type": "CPT"}, {"code": "5965014040", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 1808.82, "maximum": 6438.9, "gross_charge": 2192.0, "discounted_cash": 1917.05, "estimated_discounted_cash": 7110.08, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2652.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 3605.78, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 2627.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3011.08, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3664.32, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3844.46, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2202.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 2170.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 4554.11, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 3228.98, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 1808.82, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 3738.94, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 4881.2, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 2833.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1972.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJ TISS TXFER F/N/G/H <10SQCM", "code_information": [{"code": "14040", "type": "CPT"}, {"code": "5975992149", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1808.82, "maximum": 6438.9, "gross_charge": 2774.14, "discounted_cash": 1917.05, "estimated_discounted_cash": 7110.08, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2652.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6438.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 4119.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 3605.78, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1849.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 2627.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4119.4, 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"fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1830.84, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 2575.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"minimum": 2163.57, "maximum": 22644.55, "discounted_cash": 3710.0, "estimated_discounted_cash": 5099.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", 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"additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2163.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4868.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3011.08, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3664.32, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2163.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3844.46, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2202.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 6361.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 7634.84, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 6361.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 16016.04, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 11355.79, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 6361.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 13149.24, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 17166.38, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22644.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4868.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2163.57, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 9963.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": 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{"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1558.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4795.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2824.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 1233.0, "maximum": 4795.0, "estimated_discounted_cash": 5099.86, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1233.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1233.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3825.0, 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{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3825.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4655.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1869.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1558.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4795.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2824.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.36, "maximum": 241.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": 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{"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 59.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 59.88, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 59.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUST PARTIAL DENTURE MAND", "code_information": [{"code": "5880000169", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PARTIAL DENTURE MAND", "code_information": [{"code": "5970000169", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PARTIAL DENTURE MAND", "code_information": [{"code": "8715000169", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PARTIAL DENTURE MAND SP", "code_information": [{"code": "8715440106", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PARTIAL DENTURE MAX", "code_information": [{"code": "5880000168", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PARTIAL DENTURE MAX", "code_information": [{"code": "5970000168", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PATIRAL DENTURE MAX", "code_information": [{"code": "8715000168", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST PATIRAL DENTURE MAX SP", "code_information": [{"code": "8715440105", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADJUST SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9948", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.13, "maximum": 34.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 34.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE CHAIR FOR ESRD PT", "code_information": [{"code": "E1570", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.0, "maximum": 187.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.62, "maximum": 3120.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 67.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV HRMNL THXPY RXD", "code_information": [{"code": "4164F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV THXPYRXD/RCVD COLON CA", "code_information": [{"code": "4180F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJV TRTMT CHEMO HER2", "code_information": [{"code": "G2206", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS NO RS 12 MO", "code_information": [{"code": "M1020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADL PT MJ DEP DS RS 12 PHQ<5", "code_information": [{"code": "M1019", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADLT DISP UND/PULL ON ABV XL", "code_information": [{"code": "T4544", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 257.18, "maximum": 257.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 257.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.0, "maximum": 153.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.8, "maximum": 125.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 211.46, "maximum": 211.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 211.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.81, "maximum": 145.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.93, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 65.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 47.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 32.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 18.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 50.85, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 38.17, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.81, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 46.13, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 51.89, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.93, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 51.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM SMALLPOX/MONKEYPOX 19YRS+", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4525801537", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee 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combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"minimum": 206.72, "maximum": 206.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 206.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.45, "maximum": 1376.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 566.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1376.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 341.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 770.6, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 341.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1376.08, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 605.47, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 550.43, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 550.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.45, "maximum": 1376.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 566.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1376.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 341.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 770.6, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 341.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1376.08, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 605.47, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 761.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 338.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 39.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 93.62, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 113.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 55.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 921.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 59.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 50.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 409.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4525000225", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4555998988", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5313000019", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5361822701", "type": 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"Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5900822701", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5975999250", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6051994002", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6151000019", "type": 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"standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6430000019", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6431000019", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "G0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.14, "maximum": 146.13, "discounted_cash": 49.31, "estimated_discounted_cash": 120.88, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_percentage": 84.2, "possible_amount": 109.78, "count": "1 through 10", "median_amount": 109.78, "methodology": "percent of total billed charges", "10th_percentile": 109.78, "90th_percentile": 109.78}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 81.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 59.62, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 40.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 29.39, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 78.76, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 59.12, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 71.45, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 80.38, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 64.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "ADMIN HOME SLEEP APNEA TEST", "code_information": [{"code": "D9956", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.9, "maximum": 169.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 66.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 76.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 76.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN INFLUENZA VACCINE - ED", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5975994001", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN INFLUENZA VACCINE CPEP", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5992994001", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: 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"Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN INFLUENZA VIRUS VAC", "code_information": [{"code": "G0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.36, "maximum": 146.13, "discounted_cash": 74.54, "estimated_discounted_cash": 120.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_percentage": 84.2, "possible_amount": 108.8, "count": "15", "median_amount": 109.78, "methodology": "percent of total billed charges", "10th_percentile": 100.14, "90th_percentile": 116.36}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 81.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 59.62, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 74.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 60.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 36.35, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 29.39, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 78.76, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 59.12, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 71.45, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 80.38, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 64.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 58.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 58.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4525000224", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4555998990", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": 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"additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: 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"standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5313994027", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5360994001", "type": "CDM"}, {"code": 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"plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5361822707", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5520012344", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5700000108", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5900822707", "type": 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"standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6430000015", "type": 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"standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "8380799365", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "8385799365", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMOCOCCAL VACCINE", "code_information": [{"code": "G0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.36, "maximum": 146.13, "discounted_cash": 74.54, "estimated_discounted_cash": 120.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_percentage": 84.2, "possible_amount": 104.66, "count": "1 through 10", "median_amount": 109.78, "methodology": "percent of total billed charges", "10th_percentile": 100.14, "90th_percentile": 116.36}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 81.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 59.62, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 61.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 74.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 60.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 36.35, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 29.39, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 78.76, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 59.12, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 24.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 71.45, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 80.38, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 64.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 30.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 58.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 58.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4510994000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", 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"Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4525000223", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4555998910", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5360994000", "type": 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"Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5700994000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "5900822706", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6051994000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6151994000", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", 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{"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6335994000", "type": 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"standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6431000014", "type": 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"standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | 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Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "7810904715", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "8380799364", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMINISTRATION FLU VACCINE", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "8385799364", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 18.84, "maximum": 224.7, "gross_charge": 126.06, "discounted_cash": 74.54, "estimated_discounted_cash": 117.81, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 91.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 47.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 57.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.69, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 121.48, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.77, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 110.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 123.98, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 224.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 98.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 22.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 89.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMISSION TO MCCM", "code_information": [{"code": "G9480", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ REMOV", "code_information": [{"code": "G9410", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIT W/IN 180D REQ SURG REV", "code_information": [{"code": "G9412", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 10.0, "maximum": 81.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 66.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 81.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 39.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 43.06, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 22.76, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 33.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 19.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 24.43, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADO-TRASTUZUMAB EMT 100 MG", "drug_information": {"unit": 100.0, "type": "ME"}, "code_information": [{"code": "5210100044", "type": "CDM"}, {"code": "50242008801A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 23214.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ADO-TRASTUZUMAB EMT 160 MG", "drug_information": {"unit": 160.0, "type": "ME"}, "code_information": [{"code": "5210100053", "type": "CDM"}, {"code": "50242008701A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 23214.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ADOPTIVE IMMUNOTHERAPY", "code_information": [{"code": "S2107", "type": "HCPCS"}], "standard_charges": [{"minimum": 2581.38, "maximum": 5808.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2607.19, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 5808.1, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 5808.1, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2607.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 5808.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 5808.1, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 5808.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2581.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADP PACEMAKER DUAL R06", "code_information": [{"code": "C1785", "type": "HCPCS"}, {"code": "6400942932", "type": "CDM"}, {"code": "275", "type": "RC"}], "standard_charges": [{"minimum": 275.42, "maximum": 19286.37, "gross_charge": 21429.3, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 18043.47, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 275.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13929.04, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13929.04, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 13929.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19286.37, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 9150.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADR DEP THRPY PRESCRIBED", "code_information": [{"code": "G9894", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 597.09, "maximum": 11058.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4556.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11058.93, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 603.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1343.45, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1343.45, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 6193.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 603.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4512.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1343.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3728.63, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7821.76, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5545.83, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 6421.7, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 8383.55, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11058.93, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1343.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4865.93, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1343.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4423.57, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 597.09, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4423.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 370.19, "maximum": 11058.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4556.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11058.93, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 373.89, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 832.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 832.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 6193.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 373.89, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4512.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 832.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3728.63, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7821.76, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5545.83, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 3106.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 6421.7, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 8383.55, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11058.93, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 832.92, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4865.93, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 832.92, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4423.57, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 370.19, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4423.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23978.31, "maximum": 455894.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 455894.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 24697.66, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 33569.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 24457.88, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23978.31, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 23978.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 24843.93, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 24457.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 23978.31, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23978.51, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 23978.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15308.36, "maximum": 291054.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 291054.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 15767.61, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 21431.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 15614.53, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15308.36, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 15308.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 15860.99, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 15614.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 15308.36, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 15308.48, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 15308.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 402.56, "maximum": 4040.23, "discounted_cash": 1170.43, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 804.31, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1664.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4040.23, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 951.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 2262.53, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 951.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 1648.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 1151.47, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 1392.7, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1140.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 681.1, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 692.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 831.44, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 692.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2228.3, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1672.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 692.87, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2021.59, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2274.18, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4040.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1777.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 2119.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 1616.09, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 402.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 473.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 596.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 502.02, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 941.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 421.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 473.6, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1616.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRENOCORTICOTROPIN", "code_information": [{"code": "82024", "type": "CPT"}, {"code": "6600100031", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 28.97, "maximum": 262.85, "gross_charge": 292.06, "discounted_cash": 164.55, "estimated_discounted_cash": 281.27, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 92.69, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 54.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 39.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 110.21, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 133.3, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 109.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 65.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 32.83, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 32.83, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 32.83, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 32.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 262.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 58.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 49.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 979.03, "maximum": 4505.34, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3132.89, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1344.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 1827.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 1331.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3724.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4505.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3688.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2203.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 979.03, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 979.03, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 979.03, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 1109.56, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 1109.56, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 979.03, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 1109.56, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 1109.56, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADT 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT NO 180 DYS PHARMTHRY OUD", "code_information": [{"code": "M1036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT PD OUT MAT PR 180 DYS TX", "code_information": [{"code": "M1035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADT TKNG PHARMTHRY FOR OUD", "code_information": [{"code": "M1032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER 15M", "code_information": [{"code": "S5135", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.09, "maximum": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER DIEM", "code_information": [{"code": "S5136", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.71, "maximum": 15.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 15.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER DIEM", "code_information": [{"code": "S5102", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.0, "maximum": 50.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 50.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER HALF DAY", "code_information": [{"code": "S5101", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.12, "maximum": 13.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAYCARE SERVICES 15MIN", "code_information": [{"code": "S5100", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.19, "maximum": 2.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DISP BRIEF/DIAP ABV XL", "code_information": [{"code": "T4543", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.56, "maximum": 0.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER DIEM", "code_information": [{"code": "S5140", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.0, "maximum": 37.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 37.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT FOSTER CARE PER MONTH", "code_information": [{"code": "S5141", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.61, "maximum": 10.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT PROPHYLAXIS", "code_information": [{"code": "6400301110", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADULT PROPHYLAXIS", "code_information": [{"code": "D1110", "type": "HCPCS"}, {"code": "8715001110", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"minimum": 75.51, "maximum": 415.48, "gross_charge": 157.0, "estimated_discounted_cash": 150.53, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 132.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 171.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 76.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 232.67, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 76.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 169.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 182.81, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 141.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 166.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 75.51, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 166.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADULT PROPHYLAXIS HALF", "code_information": [{"code": "8715001115", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADULT PROPHYLAXIS HALF SP", "code_information": [{"code": "8715440048", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADULT PROPHYLAXIS SP", "code_information": [{"code": "6400661110", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADULT PROPHYLAXIS SP", "code_information": [{"code": "8715440047", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4523", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER MED", "code_information": [{"code": "T4522", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER SM", "code_information": [{"code": "T4521", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER XL", "code_information": [{"code": "T4524", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON LG", "code_information": [{"code": "T4527", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON MED", "code_information": [{"code": "T4526", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON SM", "code_information": [{"code": "T4525", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON XL", "code_information": [{"code": "T4528", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SPEECH AID", "code_information": [{"code": "D5953", "type": "HCPCS"}], "standard_charges": [{"minimum": 309.64, "maximum": 964.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 964.09, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 312.73, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 696.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 696.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 312.73, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 696.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 696.68, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 696.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 309.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADV CARE HEART DX MVP", "code_information": [{"code": "G0055", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV DEM CRGVR LIMITED", "code_information": [{"code": "G9917", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADV RHEUM PT CARE MVP", "code_information": [{"code": "G0053", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 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"standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADVNC CARE PLAN TLK DOCD", "code_information": [{"code": "1158F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"plan_name": "Commercial", "standard_charge_dollar": 178.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 178.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 69.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 81.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 103.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 68.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": 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"standard_charge_dollar": 178.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 69.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 81.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 103.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 68.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 81.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCED CARE PLAN ADDL 30 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"standard_charge_dollar": 204.95, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 122.44, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 178.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 178.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 69.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 81.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 103.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 68.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 81.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AE SCISSORS ENDO ENSIZOR 235CM", "code_information": [{"code": "4527610364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 402.09, "setting": "both", "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}], "standard_charges": [{"minimum": 75.53, "maximum": 673.83, "discounted_cash": 283.78, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 277.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 673.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 98.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 377.34, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 98.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 274.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 252.59, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 305.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.1, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 149.41, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 198.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 531.52, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 398.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 482.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 542.47, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 673.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 296.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 75.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 88.86, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 111.96, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 94.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 87.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 88.86, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}], "standard_charges": [{"minimum": 75.84, "maximum": 673.83, "discounted_cash": 272.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 277.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 673.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 98.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 377.34, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 98.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 274.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 242.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 293.16, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 239.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 143.37, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 198.32, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 531.52, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 398.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.27, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 482.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 542.47, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 673.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 296.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 75.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 89.22, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 112.42, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 94.57, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 86.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 89.22, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"minimum": 24.52, "maximum": 229.58, "discounted_cash": 89.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 103.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 103.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 79.65, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 96.34, "methodology": "fee schedule"}, {"payer_name": "Highmark 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"Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 229.58, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 24.52, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 28.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 36.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 30.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 102.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 28.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEP THRSHLD EST MLT FREQ I&R", "code_information": [{"code": "92652", "type": "CPT"}], "standard_charges": [{"minimum": 97.45, "maximum": 673.83, "discounted_cash": 371.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 277.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 673.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 98.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 377.34, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 98.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 274.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 331.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 400.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare 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total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 102.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 151.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 127.79, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 97.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 116.46, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 269.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEQUALIS BASEPLATE STANDARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6400994779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3859.17, "maximum": 76997.93, "gross_charge": 85553.26, "estimated_discounted_cash": 16377.72, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 72035.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 3859.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 55609.61, "methodology": "fee schedule"}, {"payer_name": "Highmark 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Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 55609.61, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 36531.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 36531.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76997.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 36531.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 36531.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 36531.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 36531.24, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 82.76, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 122.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 103.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 83.03, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 273.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL SET UP/TEACHING", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "4539990701", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 18.02, "maximum": 683.38, "gross_charge": 396.57, "discounted_cash": 50.27, "estimated_discounted_cash": 370.62, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 333.91, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 281.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 683.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 94.32, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 382.69, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 94.32, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 278.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "Highmark 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"plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.54, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 107.95, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 347.16, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 260.59, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 107.95, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 314.96, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 354.31, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 683.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 300.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", 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"standard_charge_dollar": 27.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23.13, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 21.82, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 273.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}], "standard_charges": [{"minimum": 3213.58, "maximum": 8990.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": 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"standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", 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"standard_charge_dollar": 114.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 16.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFB BODY FLUID CULTURE", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "6550871161", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.1, "maximum": 114.65, "gross_charge": 127.39, "discounted_cash": 46.03, "estimated_discounted_cash": 127.16, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 25.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10.8, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 23000.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFFIXUS NAIL BONE SCREW 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6400991291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.26, "maximum": 48479.4, "gross_charge": 53866.0, "estimated_discounted_cash": 6063.88, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 45355.17, 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"HMOPOSAlign", "standard_charge_dollar": 3011.08, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3664.32, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2034.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3844.46, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2202.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 482.16, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 578.69, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 482.16, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 1213.96, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 860.73, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 482.16, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 996.66, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 1301.15, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1716.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4577.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2034.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 755.21, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4577.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 686.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2034.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2034.48, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 686.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER 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4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1078.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13015.33, "maximum": 247457.6, "estimated_discounted_cash": 53914.57, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 247457.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13405.79, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 18221.46, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 13275.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13015.33, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 13015.33, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 13485.18, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 13275.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 13015.33, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 13015.44, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 13015.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6867.04, "maximum": 130561.6, "estimated_discounted_cash": 62847.06, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 130561.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 7073.05, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 9613.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6867.04, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 6867.04, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 7114.94, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 7004.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 6867.04, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 6867.1, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 6867.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, 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"methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 12764.29, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 12565.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12319.55, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 12319.65, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 12319.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE 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{"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 21138.53, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 20810.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 20402.02, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 20402.19, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 20402.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8794.67, "maximum": 167211.2, "estimated_discounted_cash": 46227.48, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 167211.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9058.51, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 12312.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 8970.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8794.67, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 8794.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 9112.16, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 8970.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 8794.67, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 8794.75, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 8794.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFX STENT BIFURCATED 22X80", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "6420800043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.77, "maximum": 28769.36, "gross_charge": 31965.96, "estimated_discounted_cash": 5524.78, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 26915.33, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 322.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20777.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 13649.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 13649.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 13649.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 13649.46, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20777.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 20777.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 13649.46, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 13649.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": 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{"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 287.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 447.44, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 5.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 447.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG BLD TYP/DIREC AGG", "code_information": [{"code": "86905", "type": "CPT"}, {"code": "6600869050", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.83, "maximum": 626.64, "gross_charge": 319.15, "discounted_cash": 16.3, "estimated_discounted_cash": 307.27, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 9.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 460.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 60.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 626.42, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 60.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 456.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 34.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.99, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.99, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.99, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.99, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 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"Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 15.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": 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Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 76.1, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 31.53, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.98, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 103.48, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 73.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 8.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 73.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AHI OR RDI INITIAL DX", "code_information": [{"code": "G8842", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"minimum": 630.49, "maximum": 2631.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2017.56, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 865.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 1176.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 857.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2175.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2631.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2143.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1280.46, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 630.49, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 630.49, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 630.49, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 714.55, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 714.55, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 630.49, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 714.55, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 714.55, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI GUIDEWIRE FIELDR .014\"X30CM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "6515811892", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 55.13, "maximum": 729.34, "gross_charge": 810.38, "estimated_discounted_cash": 304.78, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 682.33, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 55.13, "methodology": "fee 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{"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 526.74, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 526.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 729.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"minimum": 570.0, "maximum": 2623.05, "discounted_cash": 2373.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 1824.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 782.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 760.0, "methodology": "fee 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"fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 646.0, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}], "standard_charges": [{"minimum": 2756.25, "maximum": 12683.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 8820.0, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5145.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 3748.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 10486.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 12683.85, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10383.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 6203.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 2756.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 2756.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 2756.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 2756.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 3675.0, "methodology": "fee 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"Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 323.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 323.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 285.54, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 323.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 323.61, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 380.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AICC (HUMAN) 1UNIT FEIBA", "drug_information": {"unit": 1.0, "type": "UN"}, "code_information": [{"code": "5210201647", "type": "CDM"}, {"code": "64193042502A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 11.22, "setting": "both", "billing_class": "facility"}]}, {"description": "AICD GENERATOR PROCEDURES", "code_information": [{"code": "245", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49912.7, "maximum": 948979.2, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 948979.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 51410.08, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 69877.78, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 50910.95, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49912.7, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 49912.7, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 51714.55, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 50910.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 49912.7, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 49913.11, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 49912.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AICD LEAD PROCEDURES", "code_information": [{"code": "265", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39583.14, "maximum": 752585.6, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 752585.6, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 40770.63, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 55416.4, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 40374.8, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39583.14, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 39583.14, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 41012.09, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 40374.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 39583.14, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 39583.47, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 39583.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}], "standard_charges": [{"minimum": 5000.0, "maximum": 5000.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 5000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, DUAL CHAMBER", "code_information": [{"code": "C1721", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}], "standard_charges": [{"minimum": 12087.27, "maximum": 12087.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 12087.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, OTHER THAN SING/DUAL", "code_information": [{"code": "C1882", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}], "standard_charges": [{"minimum": 3988.8, "maximum": 3988.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 3988.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AICD, SINGLE CHAMBER", "code_information": [{"code": "C1722", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULAN NONEMERG ROTARY", "code_information": [{"code": "S9961", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR AMBULANC NONEMERG FIXED", "code_information": [{"code": "S9960", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR ELEVATOR FOR HEEL", "code_information": [{"code": "E0370", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.0, "maximum": 8.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}], "standard_charges": [{"minimum": 94.45, "maximum": 3120.0, "discounted_cash": 2717.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 94.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 591.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1317.42, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1317.42, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 591.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 585.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1317.42, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2213.94, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2694.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 585.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2815.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1612.77, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1317.42, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 585.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1317.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 585.52, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 585.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG I: T1 MIC/T1A", "code_information": [{"code": "G9704", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BR CA STG IB", "code_information": [{"code": "G9705", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 0 DOCD", "code_information": [{"code": "3370F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3372F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRST CNCR STAGE 1 DOCD", "code_information": [{"code": "3374F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 2 DOCD", "code_information": [{"code": "3376F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 3 DOCD", "code_information": [{"code": "3378F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC BRSTCNCR STAGE 4 DOCD", "code_information": [{"code": "3380F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 0 DOCD", "code_information": [{"code": "3382F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 1 DOCD", "code_information": [{"code": "3384F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 2 DOCD", "code_information": [{"code": "3386F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 3 DOCD", "code_information": [{"code": "3388F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CLN CNCR STAGE 4 DOCD", "code_information": [{"code": "3390F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC CNCR 0/IA MELAN DOCD", "code_information": [{"code": "3321F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC MEL CNR STG 0 - IIC", "code_information": [{"code": "G8944", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STAGE DOCD B/4 THXPY", "code_information": [{"code": "3300F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AJCC STG BRT CA DX II OR III", "code_information": [{"code": "G9831", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}], "standard_charges": [{"minimum": 10436.82, "maximum": 10436.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10436.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AK/FT POWER ASST INCL MOTORS", "code_information": [{"code": "L5969", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AL ALLODERM SELCT THIN 164SQCM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "6400995080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 33.75, "maximum": 3362.36, "gross_charge": 122.62, "estimated_discounted_cash": 11389.56, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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{"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AL ALLODERM SKINSUB 4X12CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "6400941326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 33.75, "maximum": 3362.36, "gross_charge": 122.62, "estimated_discounted_cash": 11389.56, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AL ALLODERM SKINSUB 6X12CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "6400941327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 33.75, "maximum": 3362.36, "gross_charge": 122.62, "estimated_discounted_cash": 11389.56, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AL ALLODERM SKINSUB 6X16CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "6400941328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 33.75, "maximum": 3362.36, "gross_charge": 122.62, "estimated_discounted_cash": 11389.56, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 103.24, "methodology": "fee 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billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALARM SYMP ASSESSED-ABSENT", "code_information": [{"code": "1070F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding 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"type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.09, "maximum": 97.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.48, "maximum": 1541.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 26.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 64.85, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 691.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 36.32, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 691.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.85, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 28.53, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 50ML", "code_information": [{"code": "P9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.49, "maximum": 1541.22, "estimated_discounted_cash": 480.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 691.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 90.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 691.84, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent 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"standard_charge_dollar": 1541.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 64.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 684.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 64.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.49, "maximum": 1896.77, "estimated_discounted_cash": 1320.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.13, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 851.44, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1896.77, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1896.77, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 90.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 851.44, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 843.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1896.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 843.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 162.13, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1896.77, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 843.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 843.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1896.77, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 843.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 64.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", 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"Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 3.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 4.95, "methodology": "fee 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[{"code": "5210120201", "type": "CDM"}, {"code": "00487950101A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.61, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUTEROL 0.5% NEB SOLN 2.5 MG", "drug_information": {"unit": 0.5, "type": "ML"}, "code_information": [{"code": "5210810017", "type": "CDM"}, {"code": "00487990130A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.76, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUTEROL 2 MG TABLET", "drug_information": {"unit": 2.0, "type": "ME"}, "code_information": [{"code": "5210120011", "type": "CDM"}, {"code": "53489017601", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 118.86, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUTEROL 90 MCG/ACT 60 DOSE", "code_information": [{"code": "5210120024", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 45.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.32, "maximum": 97.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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{"description": "ALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 97.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": 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"Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL INH 17 GM (OMNICELL)", "code_information": [{"code": "5210121803", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 27.06, "setting": "both", "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", 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"standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL MDI 90 MCG/PUFF INHA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5210120193", "type": 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"standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 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"code_information": [{"code": "99409", "type": "CPT"}, {"code": "6151099409", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 57.94, "maximum": 226.91, "gross_charge": 252.13, "discounted_cash": 209.27, "estimated_discounted_cash": 227.04, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 57.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 163.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 120.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.12, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 103.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 125.09, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 163.88, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 226.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 62.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 73.22, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 77.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 60.95, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 73.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCO/SUBST ABUSE SCREEN>30 MIN", "code_information": [{"code": "99409", "type": "CPT"}, {"code": "4525030028", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 57.94, "maximum": 226.91, "gross_charge": 252.13, "discounted_cash": 209.27, "estimated_discounted_cash": 227.04, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 57.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 163.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 72.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 120.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.12, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 103.18, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 125.09, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 163.88, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 226.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 62.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 73.22, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 77.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 60.95, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 73.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG ASSESS", "code_information": [{"code": "H0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.42, "maximum": 538.64, "estimated_discounted_cash": 574.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 241.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 241.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 151.35, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 92.35, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.74, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 157.2, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG HOTLINE", "code_information": [{"code": "H0030", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.76, "maximum": 4.76, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG INTERVEN", "code_information": [{"code": "H0022", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.05, "maximum": 323.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG OUTREACH", "code_information": [{"code": "H0023", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.0, "maximum": 160.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0024", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.35, "maximum": 11.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0025", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.25, "maximum": 5.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0026", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.55, "maximum": 27.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 27.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0027", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG PREVENTI", "code_information": [{"code": "H0029", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.38, "maximum": 144.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 144.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.02, "maximum": 538.64, "estimated_discounted_cash": 544.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 41.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 241.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 241.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 62.2, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 45.21, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 53.16, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 64.47, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 538.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 239.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0003", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.02, "maximum": 166.98, "estimated_discounted_cash": 346.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_percentage": 84.2, "possible_amount": 84.29, "count": "1 through 10", "median_amount": 83.44, "methodology": "percent of total billed charges", "10th_percentile": 83.44, "90th_percentile": 85.13}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 166.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 166.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 166.98, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 151.35, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 92.35, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 77.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.74, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 157.2, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 166.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 166.98, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 74.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0006", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.81, "maximum": 8.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0007", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.12, "maximum": 430.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 193.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 193.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.0, "maximum": 2912.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.92, "maximum": 2912.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 25.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.93, "maximum": 2912.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 120.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark 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{"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.35, "maximum": 2912.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "per diem"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 255.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG 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"methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}, {"code": "944", "type": "RC"}], "standard_charges": [{"minimum": 152.35, "maximum": 312.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "per diem"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}, {"code": "945", "type": "RC"}], "standard_charges": [{"minimum": 152.35, "maximum": 312.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "per diem"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.35, "maximum": 501.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 501.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": 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"plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}, {"code": "944", "type": "RC"}], "standard_charges": [{"minimum": 152.35, "maximum": 312.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "per diem"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}, {"code": "945", "type": "RC"}], "standard_charges": [{"minimum": 152.35, "maximum": 312.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "per diem"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.29, "maximum": 173.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}, {"code": "944", "type": "RC"}], "standard_charges": [{"minimum": 27.29, "maximum": 312.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "per diem"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}, {"code": "945", "type": "RC"}], "standard_charges": [{"minimum": 27.29, "maximum": 312.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "per diem"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}], "standard_charges": [{"minimum": 134.33, "maximum": 398.82, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 134.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 398.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 398.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 398.82, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}, {"code": "905", "type": "RC"}], "standard_charges": [{"minimum": 177.25, "maximum": 832.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 832.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 398.81, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 265.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 319.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}, {"code": "906", "type": "RC"}], "standard_charges": [{"minimum": 177.25, "maximum": 832.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 832.0, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 398.81, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 265.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 212.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 319.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0016", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.71, "maximum": 30.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.35, "maximum": 774.77, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 774.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0018", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.35, "maximum": 342.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0019", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.65, "maximum": 342.79, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 124.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 153.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 342.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 152.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0020", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.23, "maximum": 61.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 61.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0020", "type": "HCPCS"}, {"code": "900", "type": "RC"}], "standard_charges": [{"minimum": 27.29, "maximum": 27.29, "setting": "outpatient", "payers_information": [{"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG TRAINING", "code_information": [{"code": "H0021", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.66, "maximum": 4.66, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL OR PEROXIDE PER PINT", "code_information": [{"code": "A4244", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL USP (DEHYDRATED) 5 ML", "code_information": [{"code": "5210920086", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 209.39, "setting": "both", "billing_class": "facility"}]}, {"description": "ALCOHOL WIPES PER BOX", "code_information": [{"code": "A4245", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.14, "maximum": 2.65, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1572.55, "maximum": 294444.8, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 294444.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 15951.28, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 15022.08, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 15022.08, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 15022.08, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 1814.0, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 15022.08, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 15486.68, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 15486.81, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 15486.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG 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"methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 15796.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 826.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}, {"code": "136", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 15796.41, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 15796.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}, {"code": "146", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 15796.41, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 15796.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}, {"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 15796.41, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 15796.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1572.55, "maximum": 362980.8, "estimated_discounted_cash": 46605.23, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 362980.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19664.15, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 18518.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 18518.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 18518.67, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 1814.0, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 18518.67, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 19091.41, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19091.57, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 19091.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}, {"code": "116", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 19473.24, "estimated_discounted_cash": 46605.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", 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"plan_name": "Medicare", "standard_charge_dollar": 826.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}, {"code": "136", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 19473.24, "estimated_discounted_cash": 46605.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 19473.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}, {"code": "146", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 19473.24, "estimated_discounted_cash": 46605.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 19473.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}, {"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 19473.24, "estimated_discounted_cash": 46605.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 19473.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1572.55, "maximum": 183622.4, "estimated_discounted_cash": 21433.23, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 183622.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9947.58, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 9368.1, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 9368.1, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 9368.1, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 1814.0, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 9368.1, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_percentage": 90.0, "possible_amount": 4892.45, "count": "1 through 10", "median_amount": 6115.56, "methodology": "percent of total billed charges", "10th_percentile": 2446.22, "90th_percentile": 6115.56}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 9657.84, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 9657.92, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 9657.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}, {"code": "116", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 9851.0, "estimated_discounted_cash": 21433.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 9851.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}, {"code": "126", "type": "RC"}], "standard_charges": [{"minimum": 826.0, "maximum": 9851.0, "estimated_discounted_cash": 21433.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 9851.0, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 826.0, "methodology": 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21433.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 9851.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}, {"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 9851.0, "estimated_discounted_cash": 21433.23, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 9851.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1572.55, "maximum": 128315.2, "estimated_discounted_cash": 21533.5, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 128315.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 6951.36, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1572.55, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 6546.42, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 6546.42, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 6546.42, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 1814.0, "methodology": "per diem"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Mental Health/Substance Abuse rate", "standard_charge_dollar": 6546.42, "methodology": "case rate"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 6748.89, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 6748.95, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 6748.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}, {"code": "116", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 6883.87, "estimated_discounted_cash": 21533.5, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 6883.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}, {"code": "126", "type": "RC"}], "standard_charges": [{"minimum": 826.0, "maximum": 6883.87, "estimated_discounted_cash": 21533.5, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 6883.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 826.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}, {"code": "136", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 6883.87, "estimated_discounted_cash": 21533.5, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 6883.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}, {"code": "146", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 6883.87, "estimated_discounted_cash": 21533.5, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 6883.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}, {"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 1719.6, "maximum": 6883.87, "estimated_discounted_cash": 21533.5, "setting": "inpatient", "payers_information": [{"payer_name": "Fidelis", "plan_name": "Exchange", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 1719.6, "methodology": "per diem"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "additional_payer_notes": "Detox rate", "standard_charge_dollar": 6883.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG ABUSE SVC NOS", "code_information": [{"code": "H0047", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.2, "maximum": 323.18, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SCREENING", "code_information": [{"code": "H0049", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 145.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SERVICE 15 MIN", "code_information": [{"code": "H0050", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.26, "maximum": 323.18, "estimated_discounted_cash": 118.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 28.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUB MISUSE ASSESS", "code_information": [{"code": "G2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.0, "maximum": 145.96, "discounted_cash": 50.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 37.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.25, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 50.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 65.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 36.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 13.0, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 15.6, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 13.0, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 41.8, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 31.38, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 13.0, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 37.92, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 42.66, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 90.25, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 145.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV 15-30MN", "code_information": [{"code": "G0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.76, "maximum": 323.18, "discounted_cash": 111.51, "estimated_discounted_cash": 117.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.93, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 65.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 145.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 47.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 37.76, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 150.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 150.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 150.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 64.0, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 38.16, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 150.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 54.84, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 66.47, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.93, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 51.45, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 46.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV >30 MIN", "code_information": [{"code": "G0397", "type": "HCPCS"}], "standard_charges": [{"minimum": 70.46, "maximum": 553.9, "discounted_cash": 214.54, "estimated_discounted_cash": 229.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 228.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 553.9, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 193.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 310.18, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 193.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 225.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 70.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 70.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 70.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 70.46, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 201.09, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 201.09, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 201.09, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 151.35, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 205.86, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 201.09, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.74, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 157.2, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 553.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 243.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 430.91, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 221.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 221.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBSTANCE ABUSE SKIL", "code_information": [{"code": "T1012", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.6, "maximum": 3.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 3.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 1OR 2", "code_information": [{"code": "80321", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "discounted_cash": 36.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 3/MORE", "code_information": [{"code": "80322", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD BLU TOOTH FM/DM RECEIVER", "code_information": [{"code": "V5286", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.86, "maximum": 179.86, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 179.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM ADAPT/BOOT COUPLIN", "code_information": [{"code": "V5289", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM AUD INPUT RECEIVER", "code_information": [{"code": "V5285", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM EAR LEVEL RECEIVER", "code_information": [{"code": "V5284", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.08, "maximum": 41.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 41.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM RECEIVER, NOS", "code_information": [{"code": "V5287", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.33, "maximum": 9.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM BINAURAL", "code_information": [{"code": "V5282", "type": "HCPCS"}], "standard_charges": [{"minimum": 272.0, "maximum": 272.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM SYSTEM, MONAURAL", "code_information": [{"code": "V5281", "type": "HCPCS"}], "standard_charges": [{"minimum": 1455.26, "maximum": 1455.26, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1455.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FM/DM TRANSMITTER ALD", "code_information": [{"code": "V5288", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.02, "maximum": 130.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 130.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD FOR COCHLEAR IMPLANT", "code_information": [{"code": "V5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 691.75, "maximum": 691.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 691.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD NECK, LOOP IND RECEIVER", "code_information": [{"code": "V5283", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TELEPHONE AMPLIFIER", "code_information": [{"code": "V5268", "type": "HCPCS"}], "standard_charges": [{"minimum": 168.37, "maximum": 168.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 168.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD TRANSMITTER MICROPHONE", "code_information": [{"code": "V5290", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD UNSPECIFIED", "code_information": [{"code": "V5274", "type": "HCPCS"}], "standard_charges": [{"minimum": 593.39, "maximum": 593.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 593.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV AMPLIFIER, ANY TYPE", "code_information": [{"code": "V5270", "type": "HCPCS"}], "standard_charges": [{"minimum": 148.12, "maximum": 148.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 148.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALD, TV CAPTION DECODER", "code_information": [{"code": "V5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1600.0, "maximum": 1600.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1600.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}], "standard_charges": [{"minimum": 4079.5, "maximum": 10198.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4201.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10198.75, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5711.3, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4161.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6908.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 6908.4, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10198.75, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4487.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4079.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 6181.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 6060.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 6060.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 6060.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 6060.0, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4079.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOLASE", "code_information": [{"code": "82085", "type": "CPT"}, {"code": "6600100007", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.28, "maximum": 58.28, "gross_charge": 64.76, "discounted_cash": 41.35, "estimated_discounted_cash": 62.51, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 27.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 33.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 58.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 9.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 51.39, "maximum": 433.15, "discounted_cash": 534.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 301.2, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 129.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 115.64, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": 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{"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 94.13, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": 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"standard_charge_dollar": 3335.75, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1482.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1482.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1482.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALEMTUZUMAB 30 MG/ML VIAL", "drug_information": {"unit": 1.0, "type": "ML"}, "code_information": [{"code": "5210100014", "type": "CDM"}, {"code": "58468035703", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6882.3, "setting": 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"standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALERTING DEVICE, ANY TYPE", "code_information": [{"code": "V5269", "type": "HCPCS"}], "standard_charges": [{"minimum": 170.0, "maximum": 170.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALG BREAST IMPL SCM GEL 275CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "6400941229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.32, "maximum": 4848.21, "gross_charge": 5386.9, "estimated_discounted_cash": 4416.4, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4535.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 402.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4848.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALG BREAST IMPL SCM GEL 310CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "6400941230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.32, "maximum": 4848.21, "gross_charge": 5386.9, "estimated_discounted_cash": 4416.4, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4535.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 402.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4848.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALG INSPIRA SIZER 445CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "6400941028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.32, "maximum": 4848.21, "gross_charge": 5386.9, "estimated_discounted_cash": 4416.4, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4535.76, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 402.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3501.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4848.21, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2300.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALGINATE DRESSING > 48 SQ IN", "code_information": [{"code": "A6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.0, "maximum": 20.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.44, "maximum": 527.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 236.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 236.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 40.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 40.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.2, "maximum": 224.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 187.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.25, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 224.25, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALKALINE PHOSPHATASE ISOENZYME", "code_information": [{"code": "84078", "type": "CPT"}, {"code": "6560840781", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.08, "maximum": 62.14, "gross_charge": 69.05, "discounted_cash": 31.1, "estimated_discounted_cash": 66.47, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 11.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Highmark 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"methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 3.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 6.27, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 7.9, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 3.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 6.27, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18396.72, "maximum": 349772.8, "estimated_discounted_cash": 120745.31, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 349772.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 18948.62, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 25755.41, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 18764.65, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18396.72, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 18396.72, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 19060.84, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 18764.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 18396.72, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 18396.87, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 18396.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7289.33, "maximum": 138590.4, "estimated_discounted_cash": 21531.92, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 138590.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 7508.01, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 10205.06, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 7435.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7289.33, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 7289.33, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 7552.47, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 7435.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 7289.33, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 7289.39, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 7289.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 4.47, "maximum": 2679.88, "discounted_cash": 15.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1104.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2679.88, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 322.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 718.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 718.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 1500.73, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 322.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 1093.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 718.54, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 18.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 539.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 647.96, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 539.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1736.56, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1303.5, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 539.97, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1575.47, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1772.32, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2679.88, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 718.54, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1179.15, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 718.54, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 1071.95, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 319.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 1071.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGY/IMMUNOLOGY SS", "code_information": [{"code": "G0060", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 5.98, "maximum": 34.03, "discounted_cash": 33.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 27.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 8.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 3589.69, "maximum": 40065.8, "discounted_cash": 7053.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 16507.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40065.8, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", 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"standard_charge_dollar": 9847.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 5771.1, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 7023.11, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4376.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6266.19, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 3589.69, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 11255.28, "methodology": "case 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"methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 30373.08, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40065.8, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 9847.08, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 4376.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 17628.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 9847.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding 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43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPS COMPRESSION WIRE", "code_information": [{"code": "6400994094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALS 1", "code_information": [{"code": "A0426", "type": "HCPCS"}], "standard_charges": [{"minimum": 208.93, "maximum": 208.93, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 208.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS 2", "code_information": [{"code": "A0433", "type": "HCPCS"}], "standard_charges": [{"minimum": 573.46, "maximum": 573.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 573.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0392", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.25, "maximum": 28.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ESOPHAGEAL INTUB SUPPLS", "code_information": [{"code": "A0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.39, "maximum": 22.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 22.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS IV DRUG THERAPY SUPPLIES", "code_information": [{"code": "A0394", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.49, "maximum": 13.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS ROUTINE DISPOSBLE SUPPLS", "code_information": [{"code": "A0398", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.6, "maximum": 5.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALS1-EMERGENCY", "code_information": [{"code": "A0427", "type": "HCPCS"}], "standard_charges": [{"minimum": 219.61, "maximum": 219.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 219.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALT LONG-TERM CNTRL MED RXD", "code_information": [{"code": "4144F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE (T-PA) 100 MG/100 ML", "drug_information": {"unit": 100.0, "type": "ME"}, "code_information": [{"code": "5210201702", "type": "CDM"}, {"code": "50242008527A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE (T-PA) 100 MG/100 ML", "drug_information": {"unit": 100.0, "type": "ME"}, "code_information": [{"code": "5210922459", "type": "CDM"}, {"code": "50242008527B", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE (T-PA) 1MG/1ML SYR", "drug_information": {"unit": 1.0, "type": "ML"}, "code_information": [{"code": "5210202836", "type": "CDM"}, {"code": "50242004413D", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE (T-PA) 2 MG INJ", "drug_information": {"unit": 2.0, "type": "ME"}, "code_information": [{"code": "5210200814", "type": "CDM"}, {"code": "50242004164A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE (T-PA) 2 MG VIAL (FO", "drug_information": {"unit": 2.0, "type": "ML"}, "code_information": [{"code": "5210810206", "type": "CDM"}, {"code": "50242004164C", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE (T-PA) 50 MG/50 ML V", "drug_information": {"unit": 50.0, "type": "ML"}, "code_information": [{"code": "5210200383", "type": "CDM"}, {"code": "50242004413C", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE 2 MG/2ML (ONCOLOGY)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5210201696", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15191.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.78, "maximum": 288.5, "estimated_discounted_cash": 625.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 118.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 288.5, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 74.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 166.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 166.01, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 161.56, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 74.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 117.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 166.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 106.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 106.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 93.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 93.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 92.33, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 288.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 166.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 126.94, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 166.01, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 115.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 73.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 115.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.53, "maximum": 10518.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 5.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 4721.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 10518.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 10518.49, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 4721.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 5.8, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 10518.49, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero 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"Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 4.53, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 10518.49, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 6.26, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 10518.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 4674.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 4.61, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALUMINUM", "code_information": [{"code": "82108", "type": "CPT"}, {"code": "6600100075", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.11, "maximum": 101.0, "gross_charge": 112.23, "discounted_cash": 108.53, "estimated_discounted_cash": 107.53, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 61.15, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 26.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.62, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 61.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 61.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 27.62, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 25.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 61.54, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 72.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.99, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 43.01, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 61.54, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 27.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 101.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 26.03, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 32.46, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 26.75, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALUMINUM HYDROXIDE GEL 15 ML", "code_information": [{"code": "5210561024", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 24.04, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOL RIDGE PRESERV W/GRFT SP", "code_information": [{"code": "6400667953", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOLAR RIDGE PRESERV W/ GRAF", "code_information": [{"code": "5880992215", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOLAR RIDGE PRESERV W/ GRAF", "code_information": [{"code": "5970992215", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOLAR RIDGE PRESERV W/ GRAF", "code_information": [{"code": "8715007953", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOLAR RIDGE PRESERV W/GRAFT", "code_information": [{"code": "6400307953", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOLAR RIDGE PRESRV W/GRF SP", "code_information": [{"code": "8715440001", "type": "CDM"}, {"code": "512", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOLECTOMY", "code_information": [{"code": "41830", "type": "CPT"}, {"code": "8715041830", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 480.23, "maximum": 10346.58, "gross_charge": 5181.0, "discounted_cash": 881.64, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5794.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4221.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2213.94, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2694.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2815.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1612.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2065.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5535.53, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 4155.1, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5022.04, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5649.51, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4552.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4662.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALVEOLECTOMY SP", "code_information": [{"code": "41830", "type": "CPT"}, {"code": "8715440195", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 480.23, "maximum": 10346.58, "gross_charge": 5181.0, "discounted_cash": 881.64, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5794.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4221.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2213.94, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2694.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2815.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1612.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2065.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5535.53, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 4155.1, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5022.04, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5649.51, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4552.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4662.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALVEOLECTOMY/SEQUESTRECT", "code_information": [{"code": "41830", "type": "CPT"}, {"code": "5975222184", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 480.23, "maximum": 10346.58, "gross_charge": 6686.46, "discounted_cash": 881.64, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": 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{"description": "ALVEOLOPLASTY EACH QUADRANT", "code_information": [{"code": "41874", "type": "CPT"}, {"code": "6400660233", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 10346.58, "gross_charge": 5181.0, "discounted_cash": 789.84, "estimated_discounted_cash": 6916.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5794.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4221.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2213.94, "methodology": "case rate"}, {"payer_name": "Highmark 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"case rate"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY EACH QUADRANT", "code_information": [{"code": "41874", "type": "CPT"}, {"code": "6400820233", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 10346.58, "gross_charge": 5181.0, "discounted_cash": 789.84, "estimated_discounted_cash": 6916.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5794.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4221.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross 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"plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 4155.1, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5022.04, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5649.51, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 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"methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY EACH QUADRANT", "code_information": [{"code": "41874", "type": "CPT"}, {"code": "8715041874", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 480.23, "maximum": 10346.58, "gross_charge": 5181.0, "discounted_cash": 789.84, "estimated_discounted_cash": 6916.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5794.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 485.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4221.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1080.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2213.94, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2694.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2815.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1612.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 2065.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 5535.53, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 4155.1, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 1721.22, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item 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"standard_charge_dollar": 4662.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4138.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY EACH QUADRANT SP", "code_information": [{"code": "41874", "type": "CPT"}, {"code": "8715440196", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 480.23, "maximum": 10346.58, "gross_charge": 5181.0, "discounted_cash": 789.84, "estimated_discounted_cash": 6916.0, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": 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"payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4262.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 1428.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 1428.52, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5794.08, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4221.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1428.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10346.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 1428.52, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4552.49, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 1428.52, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": 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"ALVEOPLASTY W/ EXTRACTION", "code_information": [{"code": "D7310", "type": "HCPCS"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 400.0, "estimated_discounted_cash": 206.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/ EXTRACTION", "code_information": [{"code": "D7310", "type": "HCPCS"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 400.0, "estimated_discounted_cash": 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"standard_charges": [{"gross_charge": 221.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/O EXTRACTION", "code_information": [{"code": "D7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 173.37, "maximum": 4842.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1994.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4842.05, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 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{"description": "ALYS BRN NPGT PRGRMG 15 MIN", "code_information": [{"code": "95983", "type": "CPT"}], "standard_charges": [{"minimum": 48.58, "maximum": 296.7, "discounted_cash": 154.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 122.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 166.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 121.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 140.88, "methodology": "fee schedule"}, {"payer_name": "Highmark 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"methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 156.67, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 117.6, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 142.14, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 159.9, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 296.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 130.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 48.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 60.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 50.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG ADDL 15", "code_information": [{"code": "95984", "type": "CPT"}], "standard_charges": [{"minimum": 42.59, "maximum": 236.63, "discounted_cash": 135.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 45.84, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 124.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 150.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 123.22, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 73.61, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 42.59, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 50.1, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 63.13, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 50.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX SP/PN NPGT W/PRGRM", "code_information": [{"code": "95972", "type": "CPT"}], "standard_charges": [{"minimum": 39.65, "maximum": 296.7, "discounted_cash": 239.55, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 122.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 166.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 121.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 115.88, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 140.16, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 58.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 156.67, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 117.6, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 142.14, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 159.9, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 296.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 130.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 39.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 46.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 58.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 49.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 41.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 46.65, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AM DERMATRIX ALM 6X16CM .5-1MM", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "6400942746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25830.87, "maximum": 54444.47, "gross_charge": 60493.86, "estimated_discounted_cash": 8014.77, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 50935.83, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30246.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 39321.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "additional_payer_notes": "Pays in addition to Ambulatory Surgery", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "additional_payer_notes": "Pays in addition to Ambulatory 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"methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 54444.47, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 25830.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AM GTUBE MICKEY 20-24F ALL SZ", "code_information": [{"code": "4527610309", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.88, "setting": "both", "billing_class": "facility"}]}, {"description": "AM INFLUX SPARC (CBM) 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "6400942542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 116.0, "maximum": 17073.18, "gross_charge": 18970.2, "estimated_discounted_cash": 4067.79, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 15972.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12330.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee 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"Commercial", "standard_charge_dollar": 12330.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17073.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AM INFLUX SPARC (CBM) 15CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "6400942543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 116.0, "maximum": 17073.18, "gross_charge": 18970.2, "estimated_discounted_cash": 4067.79, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 15972.9, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12330.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12330.63, 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"standard_charges": [{"minimum": 5.85, "maximum": 527.43, "discounted_cash": 15.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 171.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 232.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 169.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 82.09, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 220.02, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.15, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 199.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 224.55, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 182.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 7.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 7.62, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW I&R", "code_information": [{"code": "93790", "type": "CPT"}], "standard_charges": [{"minimum": 19.12, "maximum": 527.43, "discounted_cash": 57.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 62.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 31.4, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 26.42, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW REC ONLY", "code_information": [{"code": "93786", "type": "CPT"}], "standard_charges": [{"minimum": 24.77, "maximum": 527.43, "discounted_cash": 87.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 171.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 232.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 169.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 63.52, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 76.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 82.09, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 220.02, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.15, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 199.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 224.55, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 182.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 527.43, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 38.82, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 24.77, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMBULANCE 02 LIFE SUSTAINING", "code_information": [{"code": "A0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.87, "maximum": 20.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE RESPONSE/TREATMENT", "code_information": [{"code": "A0998", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.42, "maximum": 92.42, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 92.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULANCE WAITING 1/2 HR", "code_information": [{"code": "A0420", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.58, "maximum": 28.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 28.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SETTING SUBSTANCE", "code_information": [{"code": "S9475", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.28, "maximum": 63.28, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 63.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.8, "maximum": 8.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY SURGICAL BOOT EAC", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMBULATORY TRACTION DEVICE", "code_information": [{"code": "E0830", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.8, "maximum": 31.8, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMEBIASIS ANTIBODY", "code_information": [{"code": "86753", "type": "CPT"}, {"code": "6600200024", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 9.29, "maximum": 180.37, "gross_charge": 200.42, "discounted_cash": 39.65, "estimated_discounted_cash": 561.9, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 29.74, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 12.64, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 42.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 20.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.53, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.53, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.53, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.53, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 18.76, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 15.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMIFOSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0207", "type": "HCPCS"}], "standard_charges": [{"minimum": 1028.55, "maximum": 6621.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1028.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2972.09, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 6621.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 6621.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2972.09, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 6621.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1221.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1221.41, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 6621.0, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 6621.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 1092.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1092.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1071.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1071.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2942.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1071.41, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1071.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMIKACIN 1 GRAM / 4 ML VIAL", "drug_information": {"unit": 4.0, "type": "ML"}, "code_information": [{"code": "J0278", "type": "HCPCS"}, {"code": "5210081247", "type": "CDM"}, {"code": "25021017304B", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.61, "maximum": 468.27, "gross_charge": 520.3, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 438.09, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": 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"plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3091.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3091.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 2979.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 2979.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 2979.56, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2979.56, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOARMOR 1 SQ CM", "code_information": [{"code": "Q4188", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.34, "maximum": 3362.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 217.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1509.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 158.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 833.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 833.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 931.0, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero 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"plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 505.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 505.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 487.59, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 487.59, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 487.59, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 487.59, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, 1 MG", "code_information": [{"code": "Q4168", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.64, "maximum": 3362.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding 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"fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "MVP 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and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 139.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 225.44, "maximum": 3120.0, "discounted_cash": 246.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 1184.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2874.33, "methodology": "fee schedule"}, {"payer_name": 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"additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2155.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 362.61, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 441.28, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 958.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 393.52, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 225.44, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 807.46, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 969.11, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 807.46, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 2032.95, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 1441.42, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 807.46, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 1669.06, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 2178.97, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2874.33, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2155.56, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 958.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 1264.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 2155.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for 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{"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 9.54, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per 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"standard_charge_dollar": 7.95, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.95, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.01, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.95, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 7.95, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 9.08, "methodology": "fee schedule"}, {"payer_name": "MVP 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"plan_name": "IndemnityPPO", "standard_charge_dollar": 2296.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2566.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2566.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 3362.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "Child Health Plus", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 2044.22, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1969.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1969.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1494.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1969.89, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1969.89, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 155.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNT PAIN NOTED PAIN PRSNT", "code_information": [{"code": "1125F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOBARBITAL 125 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0300", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.48, "maximum": 208.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 175.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 208.92, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 186.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 183.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 183.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 183.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 183.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMOX W/WO CLAV RX", "code_information": [{"code": "G9315", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOX-CLAVULANAT 875 MG TAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5210082948", "type": "CDM"}, {"code": "63187001420A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.99, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOX-CLAVULANATE 500 MG/10 ML", "drug_information": {"unit": 10.0, "type": "ML"}, "code_information": [{"code": "5210082351", "type": "CDM"}, {"code": "43598000453", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.19, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOX-CLAVULANATE TAB 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5210083490", "type": "CDM"}, {"code": "50090460402A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.21, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXAPINE 50MG TAB", "code_information": [{"code": "5210280179", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.98, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC NOT PRESC AS 1ST LINE", "code_information": [{"code": "G9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOXICIL SUSP 500 MG/10 ML OSY", "code_information": [{"code": "5210080125", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.51, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 250 MG CAP", "drug_information": {"unit": 250.0, "type": "ME"}, "code_information": [{"code": "5210084050", "type": "CDM"}, {"code": "00093310701A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 250MG/5ML SUSP **B", "drug_information": {"unit": 1.0, "type": "ML"}, "code_information": [{"code": "5210080121", "type": "CDM"}, {"code": "00093415580B", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.65, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 500 MG CAP", "drug_information": {"unit": 500.0, "type": "ME"}, "code_information": [{"code": "5210084068", "type": "CDM"}, {"code": "00093310953A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAVULANATE 875 MG", "drug_information": {"unit": 11.0, "type": "ML"}, "code_information": [{"code": "5210082989", "type": "CDM"}, {"code": "16714029302A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.12, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHET UR", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "6600100152", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.58, "maximum": 312.06, "gross_charge": 346.74, "discounted_cash": 249.21, "estimated_discounted_cash": 346.74, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 149.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 63.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 177.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 214.47, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 175.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 104.88, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent 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"standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 312.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 94.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 79.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINE/METHAMPHETAMINE UR", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "6560900003", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.58, "maximum": 312.06, "gross_charge": 346.74, "discounted_cash": 249.21, "estimated_discounted_cash": 346.74, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 149.14, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 63.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 177.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 214.47, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 175.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 104.88, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 52.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 52.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 46.61, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 52.82, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 52.82, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 312.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 63.49, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 94.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 79.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 1 OR 2", "code_information": [{"code": "80324", "type": "CPT"}, {"code": "6600250000", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.05, "maximum": 151.39, "gross_charge": 168.22, "discounted_cash": 17.02, "estimated_discounted_cash": 157.21, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 141.64, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 19.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.34, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.34, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 27.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 34.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 27.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 5.05, "discounted_cash": 17.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5 OR MORE", "code_information": [{"code": "80326", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 5.05, "discounted_cash": 17.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "United 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charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 293.5, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 293.5, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 293.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 293.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 293.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B", "drug_information": {"unit": 50.0, "type": "ME"}, "code_information": [{"code": "J0285", "type": "HCPCS"}, {"code": "5210081254", "type": "CDM"}, {"code": "39822105505C", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 42.6, "maximum": 97.83, "gross_charge": 85.64, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 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"plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 49.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 49.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.3, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 43.3, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 77.07, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 44.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 44.92, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 43.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 43.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 43.29, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 43.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B 0.15% OPHTH SOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5210520005", "type": "CDM"}, {"code": "39822105505A", "type": "NDC"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 85.64, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.3, "maximum": 527.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 236.58, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 236.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 11.97, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 527.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME 50 MG", "drug_information": {"unit": 50.0, "type": "ME"}, "code_information": [{"code": "5210081074", "type": "CDM"}, {"code": "00469305130A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 384.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.39, "maximum": 2228.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 27.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "Fidelis", 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"standard_charge_dollar": 1598.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1598.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4084.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", 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"Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2877.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4419.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2531.88, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3442.73, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7222.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5120.6, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 5929.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 7740.74, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10210.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": 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{"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1869.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1558.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4795.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2824.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 1233.0, "maximum": 4795.0, "estimated_discounted_cash": 6770.84, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1233.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 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"Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 2181.46, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 2638.48, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2877.44, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2159.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1290.35, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 6361.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 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"standard_charge_dollar": 6361.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 16016.04, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 11355.79, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 6361.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 13149.24, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 17166.38, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22644.55, 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{"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7222.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5120.6, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 5929.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 7740.74, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10210.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": 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"plan_name": "IndemnityPPO", "standard_charge_dollar": 4236.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2216.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4419.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2531.88, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3442.73, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7222.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5120.6, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 5929.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 7740.74, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10210.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 4987.12, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2216.5, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4492.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 4987.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4084.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2216.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2216.5, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4084.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1233.0, "maximum": 4795.0, "estimated_discounted_cash": 9591.94, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1233.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1233.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3825.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4655.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1869.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1558.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4795.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2824.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 1233.0, "maximum": 4795.0, "estimated_discounted_cash": 9591.94, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 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"standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3442.73, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7222.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5120.6, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF 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{"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": 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{"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31184.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 31184.5, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 32310.26, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 31808.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 31184.5, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53843.45, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 53843.45, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 55787.2, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 54920.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 53843.45, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15145.35, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 15145.35, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 15692.1, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 15448.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 15145.35, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24896.18, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 24896.18, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 25794.93, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 25394.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 24896.18, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46964.37, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 46964.37, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 48659.78, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 47903.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 46964.37, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12911.4, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 12911.4, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 13377.5, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 13169.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12911.4, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", 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{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 3343.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 4069.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1635.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1361.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 4196.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 2470.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26951", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 4196.0, "estimated_discounted_cash": 4581.6, "setting": 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"methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1819.24, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1086.83, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3442.73, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7222.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5120.6, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 5929.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 7740.74, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10210.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 5684.36, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2526.38, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4492.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 5684.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4084.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2526.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2526.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", 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"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], 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"methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 18448.7, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 15371.37, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 38700.91, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 27439.96, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 15371.37, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 31773.62, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 41480.58, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 54717.95, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 6228.35, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2768.16, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 24075.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 6228.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding 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"Essential Plan", "standard_charge_dollar": 5684.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 4084.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 2526.38, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 2526.38, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 4084.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "617", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20461.1, "maximum": 389022.4, "estimated_discounted_cash": 47452.96, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 389022.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 21074.93, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 28645.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 20870.32, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20461.1, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 20461.1, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 21199.75, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 20870.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 20461.1, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 20461.27, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 20461.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "616", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38152.19, "maximum": 725379.2, "estimated_discounted_cash": 99085.41, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 725379.2, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 39296.76, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 53413.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 38915.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38152.19, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 38152.19, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 39529.48, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 38915.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 38152.19, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 38152.5, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 38152.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "618", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15516.22, "maximum": 295006.4, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 295006.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 15981.71, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 21722.71, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 15826.54, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15516.22, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 15516.22, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 16076.36, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 15826.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 15516.22, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 15516.34, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 15516.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 2531.88, "maximum": 10210.98, "discounted_cash": 4265.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 4206.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10210.98, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 2660.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 5926.94, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 5926.94, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 5718.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 2660.54, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 4166.08, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2634.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 5926.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3481.27, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 4236.5, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2634.2, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4419.65, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2531.88, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 3442.73, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 7222.02, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 5120.6, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 2868.47, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 5929.31, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 7740.74, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10210.98, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 5926.94, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 2634.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 4492.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 5926.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data 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{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 27.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 34.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 27.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 3 OR MORE", "code_information": [{"code": "80328", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", 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"standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANACAULASE-BCDB 8.8% GEL 1 G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7353", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.42, "maximum": 883.64, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 73.38, "methodology": "fee 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{"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 6.06, "methodology": "fee 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{"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 115.36, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 77.11, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 173.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 77.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 115.36, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 117.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 77.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 138.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 174.7, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 146.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 77.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 121.13, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 138.65, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 115.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAKINRA 100MG/0.67ML SYN", "code_information": [{"code": "5210922473", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 60.94, "setting": "both", "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14318.29, "maximum": 272230.4, "estimated_discounted_cash": 103784.94, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 272230.4, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 14747.84, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 20045.61, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 14604.66, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14318.29, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 14318.29, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 14835.18, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 14604.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 14318.29, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 14318.4, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 14318.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25113.89, "maximum": 477484.8, "estimated_discounted_cash": 14.44, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 477484.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 25867.31, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 35159.45, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 25616.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25113.89, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 25113.89, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 26020.5, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 25616.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 25113.89, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 25114.09, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 25113.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9524.37, "maximum": 181084.8, "setting": "inpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 181084.8, "methodology": "case rate"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 9810.1, "methodology": "case rate"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 13334.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 9714.86, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9524.37, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 9524.37, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "standard_charge_dollar": 9868.2, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 9714.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 9524.37, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 9524.45, "methodology": "case rate"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 9524.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL PRESSURE RECORD", "code_information": [{"code": "91122", "type": "CPT"}], "standard_charges": [{"minimum": 173.04, "maximum": 624.02, "discounted_cash": 389.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 174.77, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 389.34, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 389.34, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 174.77, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 389.34, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 624.02, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 510.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 305.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 389.34, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 389.34, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 275.63, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 324.27, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 408.58, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 343.73, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 293.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 324.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}], "standard_charges": [{"minimum": 42.99, "maximum": 3844.46, "discounted_cash": 3710.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 394.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 958.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 536.75, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 391.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 3011.08, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 3664.32, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3844.46, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 2202.36, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 269.25, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "CF $77.05", "standard_charge_dollar": 323.16, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 269.25, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "CF $161.63", "standard_charge_dollar": 677.91, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "CF $114.60", "standard_charge_dollar": 480.66, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "CF $64.20", "standard_charge_dollar": 269.25, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "CF $132.70", "standard_charge_dollar": 556.57, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "CF $173.24", "standard_charge_dollar": 726.6, "methodology": "case rate"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.48, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 421.73, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 383.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 42.99, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 383.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 670.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL 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{"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51784", "type": "CPT"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, 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{"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 173.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2815.24, "methodology": "case rate"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 1612.77, "methodology": "case rate"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.08, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 154.9, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.08, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 415.13, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 311.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 129.08, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 376.62, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": 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"setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "362", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "367", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "499", "type": "RC"}], "standard_charges": [{"minimum": 803.0, "maximum": 3129.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 803.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 2492.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 3031.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 1218.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 1015.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 3129.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 1842.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESIA", "code_information": [{"code": "D9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.97, "maximum": 2942.37, "estimated_discounted_cash": 59.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 13.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 1320.8, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 2942.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 2942.37, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 1320.8, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 2942.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 2942.37, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 2942.37, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 1307.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [{"code": "80331", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANALYS IMPL NEUROSTIM W/ REPRG", "code_information": [{"code": "95971", "type": "CPT"}, {"code": "5940095971", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 38.39, "maximum": 429.93, "gross_charge": 477.71, "discounted_cash": 125.08, "estimated_discounted_cash": 454.27, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 402.23, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 122.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.7, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 166.15, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 121.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 112.57, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 136.15, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 111.47, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 66.59, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 58.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 156.67, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 117.6, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 48.72, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 142.14, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 159.9, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 296.7, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 130.55, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 38.39, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 45.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 56.9, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 47.87, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 40.14, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 45.16, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYS IMPL NEUROSTIM W/OREPRG", "code_information": [{"code": "95970", "type": "CPT"}, {"code": "5940095970", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 18.02, "maximum": 415.2, "gross_charge": 353.85, "discounted_cash": 74.38, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 297.94, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 171.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 232.51, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 169.4, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 53.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 64.16, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.53, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 31.38, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 82.09, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 220.02, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 165.15, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.41, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 199.61, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 224.55, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 182.69, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 318.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 22.47, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 25.62, "maximum": 373.97, "discounted_cash": 427.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 67.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 72.32, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 91.07, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 72.32, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 66.35, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 309.19, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 373.97, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 306.14, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 182.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 28.36, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 34.03, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 28.36, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 91.2, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 68.46, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 28.36, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 82.74, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 93.08, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 162.63, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 71.56, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 161.11, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 71.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 65.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 219.11, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 257.78, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 273.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 239.42, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 257.78, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 65.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS OF SALIVA SAMPLE", "code_information": [{"code": "D0418", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.44, "maximum": 121.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 36.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 54.33, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 121.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 121.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 54.33, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 121.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 121.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 121.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 90.95, "maximum": 531.68, "discounted_cash": 111.38, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 219.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 531.68, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 101.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 297.74, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 101.91, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 216.92, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 247.04, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 298.79, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 244.59, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 146.12, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 90.95, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 109.14, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 90.95, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 292.49, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 219.55, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 90.95, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 265.36, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 298.51, "methodology": "other"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 531.68, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 233.94, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 212.67, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 126.26, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 148.54, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 187.16, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 157.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 100.9, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 141.97, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 148.54, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 212.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE PACEMAKER SYSTEM", "code_information": [{"code": "93724", "type": "CPT"}], "standard_charges": [{"minimum": 71.31, "maximum": 958.48, "discounted_cash": 81.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 394.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 958.48, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 536.75, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 106.22, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 391.06, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 236.63, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 145.82, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 105.17, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 119.37, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 71.31, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 159.17, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 191.0, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 159.17, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 511.91, "methodology": "other"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit | Service/Procedure/Item is paid as: Other.", "standard_charge_dollar": 384.25, "methodology": "other"}, 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"fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 35.85, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 42.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 53.15, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 42.18, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 2358.84, "maximum": 5973.25, "discounted_cash": 5375.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 2358.84, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}, {"code": "369", "type": "RC"}], "standard_charges": [{"minimum": 264.0, "maximum": 1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": 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1138.0, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 264.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 905.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 1102.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 400.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 332.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 1138.0, "methodology": "case rate"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 670.0, "methodology": "case rate"}], 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 11.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 11.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1 MG TABLET", "drug_information": {"unit": 1.0, "type": "ME"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5210100732", "type": "CDM"}, {"code": "60687011221A", "type": "NDC"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 503.61, "gross_charge": 559.57, "estimated_discounted_cash": 1.64, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 471.15, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 279.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 503.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANBX 30 PRIOR TO EPISODE", "code_information": [{"code": "G9703", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 7.3, "maximum": 41.58, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 28.92, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 34.38, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 41.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 10.24, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "MVP 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"United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "274", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 6063.88, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_percentage": 42.7, "possible_amount": 937.59, "count": "1 through 10", "median_amount": 886.29, "methodology": "percent of total billed charges", "10th_percentile": 455.44, "90th_percentile": 1471.05}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_percentage": 42.7, "possible_amount": 2499.77, "count": "42", "median_amount": 1819.79, "methodology": "percent of total billed charges", "10th_percentile": 1140.66, "90th_percentile": 4849.17}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_percentage": 42.7, "possible_amount": 2313.51, "count": "97", "median_amount": 1691.37, "methodology": "percent of total billed charges", "10th_percentile": 75.0, "90th_percentile": 5575.54}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_percentage": 42.7, "possible_amount": 841.95, "count": "1 through 10", "median_amount": 623.72, "methodology": "percent of total billed charges", "10th_percentile": 451.91, "90th_percentile": 1279.05}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_percentage": 42.7, "possible_amount": 2200.46, "count": "125", "median_amount": 1523.75, "methodology": "percent of total billed charges", "10th_percentile": 75.0, "90th_percentile": 4849.17}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "275", "type": "RC"}], "standard_charges": [{"estimated_discounted_cash": 6063.88, "setting": "outpatient", "payers_information": [{"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_percentage": 42.7, "possible_amount": 937.59, "count": "1 through 10", "median_amount": 886.29, "methodology": "percent of total billed charges", "10th_percentile": 455.44, "90th_percentile": 1471.05}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_percentage": 42.7, "possible_amount": 2499.77, "count": "42", "median_amount": 1819.79, "methodology": "percent of total billed charges", "10th_percentile": 1140.66, "90th_percentile": 4849.17}, {"payer_name": "Univera", "plan_name": "Access", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_percentage": 42.7, "possible_amount": 2313.51, "count": "97", "median_amount": 1691.37, "methodology": "percent of total billed charges", "10th_percentile": 75.0, "90th_percentile": 5575.54}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_percentage": 42.7, "possible_amount": 841.95, "count": "1 through 10", "median_amount": 623.72, "methodology": "percent of total billed charges", "10th_percentile": 451.91, "90th_percentile": 1279.05}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_percentage": 42.7, "possible_amount": 2200.46, "count": "125", "median_amount": 1523.75, "methodology": "percent of total billed charges", "10th_percentile": 75.0, "90th_percentile": 4849.17}, {"payer_name": "Univera", "plan_name": "Special Programs", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.7, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANDROGEN RECPT MUTAT ANALYS", "code_information": [{"code": "81204", "type": "CPT"}, {"code": "6600581405", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 83.83, "maximum": 485.89, "gross_charge": 539.88, "discounted_cash": 427.78, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 328.8, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 141.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 191.8, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 139.74, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 390.94, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 472.84, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 387.07, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 231.24, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 102.75, "methodology": "fee 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"plan_name": "Essential Plans", "standard_charge_dollar": 83.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 83.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 485.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 137.06, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 83.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 161.25, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 203.18, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 170.93, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 83.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 137.6, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 161.25, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 23.7, "maximum": 98.91, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 75.84, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 32.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 44.24, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 32.23, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 81.78, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 98.91, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.58, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 48.14, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 23.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 23.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 23.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 26.86, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 26.86, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 23.7, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 26.86, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 26.86, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 21.62, "maximum": 99.51, "discounted_cash": 122.83, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 69.19, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 29.69, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 40.36, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 29.41, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 82.27, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 99.51, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 81.45, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 48.66, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 29.45, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 43.66, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 36.73, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 30.27, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTENEDIONE", "code_information": [{"code": "82157", "type": "CPT"}, {"code": "6600100037", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.96, "maximum": 115.23, "gross_charge": 128.04, "discounted_cash": 124.72, "estimated_discounted_cash": 121.34, "setting": "both", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 70.27, "methodology": "fee schedule"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Child Health Plus", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential Aliessa", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Essential QHP", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Exchange", "standard_charge_dollar": 40.99, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicaid", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "Fidelis", "plan_name": "Medicare", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Essential Plan", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "HMOPOSAlign", "standard_charge_dollar": 83.55, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "IndemnityPPO", "standard_charge_dollar": 101.05, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicaid", "additional_payer_notes": "Per Service Rate", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Advantage", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "Highmark BlueCross BlueShield", "plan_name": "Medicare Zero Premium", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Child Health Plus", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 1-2", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Essential Plan 3-4", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "HMO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medicare", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Medisource", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "PPO", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "Independent Health", "plan_name": "Self-Funded", "additional_payer_notes": "Per Unit", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Government Programs", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "MVP Health Plan", "plan_name": "Medicare", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Child Health Plus", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Essential Plan", "standard_charge_dollar": 82.12, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicaid", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicare", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Access", "standard_charge_dollar": 29.91, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Child Health Plus", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Commercial", "standard_charge_dollar": 35.19, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 1-2", "standard_charge_dollar": 44.34, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Essential Plans 3-4", "standard_charge_dollar": 37.3, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicaid", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Medicare", "standard_charge_dollar": 30.74, "methodology": "fee schedule"}, {"payer_name": "Univera", "plan_name": "Special Programs", "standard_charge_dollar": 35.19, "methodology": "fee schedule"}, {"payer_name": "Wellcare", "plan_name": "Medicare", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANEMIA PLAN OF CARE DOCD", "code_information": [{"code": "516F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES C HYST FLWG NEURAXIAL", "code_information": [{"code": "1969", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN DELIVERY ONLY", "code_information": [{"code": "1961", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN HYSTERECTOMY", "code_information": [{"code": "1963", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP EMERGENCY COND", "code_information": [{"code": "99140", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR CRV/THRC", "code_information": [{"code": "1937", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR LMBR/SAC", "code_information": [{"code": "1938", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES DX SHOULDER ARTHROSCOPY", "code_information": [{"code": "1622", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES END, 1 TEMP >35.5(95.9)", "code_information": [{"code": "G9771", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR DIPHRG HRNA", "code_information": [{"code": "756", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR LMBR&VNT&/DEHS", "code_information": [{"code": "752", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR OMPHALOCELE", "code_information": [{"code": "754", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR UPR ABD NOS", "code_information": [{"code": "750", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD NOS", "code_information": [{"code": "790", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST NDSC NOS", "code_information": [{"code": "811", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST SCR COLSC", "code_information": [{"code": "812", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES MEDIASCPY & DX THORSCPY", "code_information": [{"code": "528", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES MEDSCPY&THORSCPY 1 LUNG", "code_information": [{"code": "529", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT CRV/THRC", "code_information": [{"code": "1941", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT LMBR/SAC", "code_information": [{"code": "1942", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT CRV/THRC", "code_information": [{"code": "1939", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT LMBR/SAC", "code_information": [{"code": "1940", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES PX MAJ ABD BLOOD VESSEL", "code_information": [{"code": "770", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANSTHOR W/VENT", "code_information": [{"code": "626", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX ERCP", "code_information": [{"code": "732", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX NOS", "code_information": [{"code": "731", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES UPR LWR GI NDSC PX", "code_information": [{"code": "813", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES URGENT HYSTERECTOMY", "code_information": [{"code": "1962", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES VAGINAL DELIVERY ONLY", "code_information": [{"code": "1960", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES XTRNL CEPHALIC VERSION", "code_information": [{"code": "1958", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH 60 MIN/> AS DOCD", "code_information": [{"code": "4255F", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "820", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ACHILLES TENDON SURG", "code_information": [{"code": "1472", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 84.2, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Aetna", "plan_name": "Medicare", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MVP Health Plan", "plan_name": "Essential Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMNIOCENTESIS", "code_information": [{"code": "842", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_per